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The 10 Biggest Legal Mistakes Physicians Make When Filing a Disability Claim (Mistake #2)

Disability Claim Denials, Filing Disability Claims, Publications/Articles

Continuing with the list of the Ten Biggest Legal Mistakes Physicians Make is Mistake #2.

MISTAKE NO. 2: Misunderstanding the Definitions of “Disability” and “Occupation”

The definition of “disability” varies from policy to policy, as there is no standardization among disability insurance policies. Most physicians have purchased “own-occupation” policies which provide compensation if the insured is unable to perform the particular duties of his or her occupation. Even if the insured could perform work in a different occupation, own-occupation policies will provide full benefits. The issue in these cases is often the definition of “total disability,” which can have various meanings such as the insured being unable to perform all duties of his or her occupation, or merely being unable to perform the “substantial and material duties” of his or her occupation. “Occupation” may also be broadly or narrowly defined, and specifically defined in the policy or defined as the insured’s occupation immediately prior to the disabling condition. If the latter, then a physician who reduces his or her hours prior to filing for benefits may be considered to have a part-time occupation. Insurers may also define occupation as not only the physician’s duties in his or her specialty, but also including other areas such as business management, teaching, or travel. The insurer may assert that an insured is really an “internist/professor/business owner” and may not be totally disabled if he or she is still capable of performing management duties.

Action Step: Physicians should read and fully understand their policy terms before filing a claim for benefits.

The disability insurance attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Scottsdale, Tucson, Flagstaff and Yuma. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.

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