Updated: Sep 16, 2020
During my 30+ years of working with professional clients, I found that physician disability insurance is more understandable when I provide claim examples. Here’s an example of a physician who needed to file a Residual Disability Claim and learned how important it is to have the right words and phrases in his disability insurance contract!
IF my client had coverage with most Medical Association plans, he would NEVER have qualified for a benefit.
A few years ago, a client called to initiate a claim on his physician disability insurance policy. His claim was rather unique because he was not able to obtain a medical diagnosis after visiting with several doctors. The symptoms clearly showed that he was limited in his practice and the limitations caused a significant loss of income. So the question was, “Can I receive a disability insurance benefit without a medical diagnosis?”
By working closely with the insurance company’s claim department, the claim was approved for a Residual Disability Benefit. My client was not Totally Disabled (per his physician since he could still work) but did receive a Residual (partial) Disability Benefits for several years due to the limitations and loss of income.
The most interesting aspect of the claim was that he received his full monthly benefit for the majority of the time he was on claim.
NOTE: The contractual terms in a physician disability policy are very important. When you purchase disability insurance, you are purchasing the words and phrases in the contract. Plus, you should select an insurance company that has integrity when managing disability claims.
So how did my client receive his full benefit? The contract he purchased stated “If your loss of monthly earnings is more than 75% of your prior monthly earnings, it will be deemed a 100% loss and we will pay you as if you are totally disabled”. Thus, my client was still able to work in his practice but due to the significant loss of income, he received his full monthly benefit. IF my client had coverage with most Medical Association plans, he would NEVER have qualified for a benefit.
Suggestion: Find or select an agent that has experience in dealing with physician and surgeon disability insurance claims. Most importantly, find an agent that understands disability insurance contract language.
Our agents have over 20 years of experience working with claims and contract language. If you’re not certain your contract is worded the way it should be to give you the coverage you need, contact us to provide a policy review.