Understanding & Navigating Long-term Disability Claims for Physicians – Part 1

{3:20 minutes to read} To successfully represent doctors in long-term disability (LTD) claims, there are many important, core concepts that your attorney needs to understand. Because of the potential for complications, an attorney must understand the physician’s policies, as well as any agreements with his or her respective practice(s). 

The key to successfully representing doctors in LTD cases is to have an in-depth understanding of three distinct components of any case:

1. The physician’s multiple contracts and agreements;

2. The broad range of occupational duties; and

3. The difference between a total disability and a residual disability as it pertains to the claim.

Understanding Multiple Contracts & Agreements 

To provide advice and make recommendations to the physician on how to manage the LTD claims process or strategically handle a lawsuit, and everything in between, your attorney needs to understand and navigate through a multitude of contracts. 

Even within the LTD umbrella, there are many different types of policies. Typically, doctors purchase an individual disability income policy directly from a company by way of a broker. Physicians who are affiliated or work with a hospital, or work for a group of practices, may also be covered under a group policy, which can be utilized either as primary or supplemental coverage. 

Doctors who own or are partners in a practice can purchase a variety of coverage options, including: 

Disability buyout insurance—coverage designed to fund the purchase of the value of the policyholder’s equity interest in the practice;

Business overhead expense policies—which will cover typical business expenses incurred while the policyholder is disabled;

Catastrophic coverage—which will pay a lump sum in the event that the policyholder is unable to permanently return to the profession;

Life insurance policies—containing a waiver of premium provisions in the event that the policyholder is disabled within the meaning of the waiver of premium provisions contained in the policy; or

The Practice Ownership Agreement—which sets out the terms to qualify as disabled, to withdraw and retire as disabled, as well as the process of acquiring and the value of the disabled owner’s interest in the practice. 

In our next article, we will evaluate the definitions of occupational duties of physicians and explore the difference between total disability & residual disability. If you have questions about an LTD claim, please contact us to discuss your specific circumstances.

Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
833-824-5350
[email protected]