When emergency room physicians file a claim for long-term disability (LTD) benefits, they frequently face claims representatives who have no idea what the job of an ER doctor entails. They often misclassify the occupation as one that either “light or heavy duty” with no real understanding of what the workday is like.
Claimant Has the Burden of Proving the Inability to Perform the Duties of the Occupation
To have their claim for LTD benefits approved, ER doctors must prove they are unable to perform the duties of their occupation. This means they must lay out to the claims representative exactly what their duties are.
ER doctors are generally hired by a hospital and work 12-hour shifts three days a week. During this time, they treat patients with all sorts of maladies ranging from those suffering from gunshot wounds to those who complain of having had a headache for a few days.
There is no typical day. Every day, every hour, is filled with stress as the doctor moves from patient to patient. The doctor must think quickly and determine what specialists may need to be called in, determine if a patient needs surgery, or if a patient needs to be admitted to the hospital.
The job is also physically demanding. Patients must be lifted from their chair or bed, must be turned from side to side, and sometimes, those patients are very heavy. Sometimes they are unconscious and provide no assistance themselves.
Even if the claims representative says, “Ok. I agree with the duties you have described. Now show me why you cannot perform those duties.”
Medical Records Must Support the Claimed Disability: Diagnosis Alone Does Not Equal Disability
Too often, doctors work through their pain. They like their jobs and prefer to work than to quit and go on disability. They also, far too frequently, treat informally with their peers so their medical records are devoid of information needed to support their claim for disability. Without this evidence, the LTD claim will be denied.
ER doctors may fight this potential denial by undergoing neurological testing. This may show that the doctor suffers from deficits that make it impossible for him or her to perform the physical duties of the occupation.
An ER doctor who has significant pain may also convince the disability insurance that it is unsafe for patients for the doctor to continue working when he or she cannot concentrate and loses focus. Safety to the patients should be the utmost concern.
Doctors Beware: Disability Insurance Companies Extensively Use Video Surveillance
Disability insurance companies are notorious for using video surveillance on doctors. They may show the doctor at Home Depot getting materials to work on a project, or attending their child’s ballgame, or playing catch with that child. Then, the insurance company will say, “Look here what this guy did during the two hours we were surveilling him, so we think he can work those 12-hour shifts.”
The company also monitors social media. If the doctor has mentioned anything the company believes they can use to show the doctor does not have the limitations the doctor has claimed to have, the company will use that against the doctor.
Private Disability Policies Are Better Than Employer-Provided Policies Which are Covered by ERISA
ER doctors generally believe that the LTD benefit provided by their hospital employer is sufficient. Unfortunately, the employee benefits policy is not nearly as good as a private disability policy. It pays less even if the claim is approved. In addition, the company has no incentive to pay. If they go to court, there is no right to a jury trial. If the company loses, its only penalty is to pay you the money it owes you.
If you are an ER physician who is thinking about filing a claim, or in the middle of trying to get your claim approved, contact one of our long term disability attorneys at Dell Disability Lawyers. We offer a free consultation and work with clients anywhere in the country.