By Bryn Natland
You have spent your entire career specializing in one medical specialty. We have spent our entire careers specializing in one area of law. If you were sick, you would go to a specialist. If you are facing a legal issue, you want an attorney who specializes in that area of the law.
Eddie Dabdoub and the attorneys at Dabdoub Law Firm have established themselves as experts in handling physician disability insurance claims. After nearly two decades of representing physicians from all medical specialties suffering from various medical conditions, they understand the unique challenges physicians face when disabilities impede their practice.
Client Success: Liver Transplant Surgeon Wins Disability Benefits under an Own Occupation Policy
Dabdoub Law Firm represented a liver transplant surgeon who suffered a wrist injury preventing him from being able to perform long and arduous liver transplant surgeries. However, he was able to continue doing general surgery and performing his academic responsibilities at the teaching hospital where he worked. His own occupation disability claim was denied by Ameritas when they claimed he was not totally disabled because he performed other surgeries aside from liver transplants and continued teaching.
Attorneys Eddie Dabdoub and Nina Burgos filed a lawsuit against Ameritas in federal court in pursuit of their client’s disability insurance benefits. It was their position that Ameritas got their client’s occupation wrong. They argued that although their client could perform some duties of his occupation, it was not the main duty of his specialty. The other surgeries and teaching responsibilities were customary parts of his role as a liver transplant surgeon. Attorneys Dabdoub and Burgos challenged Ameritas’ denial by asserting that the inability to perform liver transplants—the core function of their client’s medical specialty—constituted a total disability under the policy. Although Ameritas tried to muddy the waters and complicate the occupation, it was very simple – their client was a liver transplant surgeon who could no longer perform liver transplants. Thus, he is totally disabled under the terms of his own occupation disability policy. The federal court agreed with the firm and awarded total disability benefits be paid to their client plus attorney’s fees paid to Dabdoub Law Firm.
Expertise in Physician Own Occupation Disability Claims
You have spent years in education and training to become an expert in your medical specialty. But most of the time you weren’t educated or trained in what to do when you fall ill or injured and can no longer perform the duties of your medical specialty. What happens when you can no longer work as a cardiac surgeon or an emergency room physician or a liver transplant surgeon?
Most physicians have “own occupation” disability insurance policies. These policies are designed to provide benefits when a physician is unable to perform the specific duties of their medical specialty, even if they can work in another capacity. It is important before you are facing a disability claim, that you review and understand your disability insurance policy. An experienced disability insurance attorney can walk you through the definitions and requirements under the policy.
One of the biggest mistakes we see when a physician becomes disabled and can no longer perform the duties of their job, is they cut back at work. But by the time they are ready to file their disability claim, they have cut back on procedures and surgeries so much that they have altered the duties of their occupation. At that point the disability insurance company will argue they are no longer practicing within their medical specialty and instead will water down their occupation making an approval of benefits very difficult. In addition, insurance companies employ tactics to delay or deny these claims, such as requesting excessive information or approving only partial disability benefits.
Navigating the Claims and Investigation Process
Filing a disability claim involves a thorough investigation by the insurance company, which typically involves requests for comprehensive documentation related to the physician’s practice and medical condition. This request often includes:
- Medical records
- Support from treating providers
- CPT codes and billing information
- Profit and loss statements
- Interview with the insurance company
Ensuring that your occupation is presented in a clear and concise manner is imperative. Some disability insurance companies use tactics to delay or deny claims, such as misclassifying a physician’s occupation to suggest they were performing a less demanding occupation prior to disability or that they are capable of performing another medical specialty. The insurance companies also often ask for redundant and unnecessary documentation, which can cause undue delays in the claim process. You want to be sure that when you are submitting information and documentation it is information that the insurance company needs to analyze your claim.
Guidance for Physicians Facing Disability
Physicians considering filing a disability insurance claim should take proactive steps to strengthen their case:
- Maintain Detailed Medical Records: Comprehensive documentation of the medical condition and how it impacts your abitlity to perform your own occupation, i.e. your medical specialty, is crucial.
- Communicate Openly with Treating Physicians: Ensure that healthcare providers understand the specific demands of the medical specialty and can provide informed opinions on your disability’s impact.
- Understand the Insurance Policy: Familiarity with the terms and definitions within the policy, particularly the definition of “total disability,” is essential.
- Seek Specialized Legal Assistance: Engaging a law firm experienced in physician disability claims can provide invaluable support throughout the process, or even before you decide to stop working.
Help from a Lawyer with Expertise in Disability Insurance Law and Physician Disability Claims
If you are facing a disability claim or just have questions about your disability insurance policy, call 888-812-0393 to speak with an attorney today or visit our website at www.longtermdisability.net to learn more about our experience and expertise with physician disability insurance claims.
