Own Occupation Physician Disability Insurance

Own occupation disability insurance for physicians is often difficult to analyze. The insurance company will try to claim the doctor can still perform their duties even with a disability. However, some doctors have duties that make it impossible to perform if disabled.

Shopping for insurance is never a quick or simple process. Insurance policies are very nuanced and packed with tons of valuable information that’s not always easy to understand.

Own Occupation Physician Disability Insurance Explained

In the event that you become disabled and can no longer conduct your specific job or any portion of it, all you’ll really want in a disability insurance policy is to protect you from going without an adequate income for any period of time.

An own occupation physician disability insurance plan is the most effective plan to protect you if you’re unable to work due to a disability.

Many insurance policies state that you must be “flat on your back” disabled in order to qualify for benefits.

Except, what if you specialize in procedures to generate 80% of your income and you’re involved in an accident that forces you to amputate your hand? If your policy states that you must be “flat on your back” to provide coverage, you’ll be left to fend for yourself.

It’s for that reason why you should look for an own occupation policy with a broad definition of “disability.” That way, the insurance company cannot tell you there are other jobs related to your field you can still perform, which makes you ineligible for benefits.

Specialty Occupation Disability Insurance Policies for Physicians

Specialty occupation policies for physicians are a specific type of disability insurance policy that covers a physician’s specialty should they become disabled from working in that particular area of medicine. For example, an orthopedic surgeon who can no longer perform orthopedic surgeries would be entitled to disability benefits for that reason if they have a specialty occupation policy.

Physicians spend years in school and training to become doctors. Often, they take a path to a medical specialty that requires additional training and education. But what happens if they become disabled and are no longer able to work in that specialty?

Specialty occupation policies can protect a physician from that situation. Even if the physician is capable of working in a different occupation or specialty, the key is that they are no longer able to perform the duties of their recognized medical specialty.

Occupation Class Regarding Physician Disability Insurance

If you are a physician shopping for occupational disability insurance, you may have come across the term “occupation classes.”

There are serious implications for different occupation classes, so it’s important to know which classification your occupation falls under.

Occupation Class

Insurance companies lump several occupations into various classes, in order to simplify the purchasing process. Each company handles this in its own unique way, but the following are the standard categories:

Typically, the higher the classification number, the lower the insurance rate will be (excluding other elements such as age, health, and income).

A Sample Breakdown of the System

“M” is for medical professionals
Salespeople tend to fall under 2A-5A, depending on the following factors:
- Income
- Nature of the sales
- Length of employment
Nurses usually fall under 2A
Most engineers fall under 4A or 5A
Most executives fall under 5A or 6A

How Occupation Class Impacts Coverage

Occupation class can impact coverage in at least the three following ways:

It can impact the amount of your monthly benefit.
1. The amount of coverage you receive depends on your level of income. Occupation classes help insurers determine the amount of coverage they’ll have to pay you in the event you need to receive the benefit.
It can limit your ability to obtain own occupation definitions in your coverage.
1. Your occupation classification will be used to determine whether your policy will have an “own occupation” or “any occupation” definition. Most occupation classes of 4A, 4M, or higher will offer “own occupation” as the base definition of the policy. Other occupation classes, such as 2A and 3A are typically offered an “any occupation” base definition.
It can limit how much mental/nervous coverage you can obtain.
1. It’s common for disability insurance companies to only offer two years of coverage for mental or nervous disabilities. However, certain companies offer more lenient or strict coverage for these disabilities depending on the occupation class.
2. For example, a company may provide up to five years of benefits for mental or nervous disabilities for 3A and 4A benefit classes, but the benefit period may be limited to just two years if you are a 4M or 5M occupation class.

Shopping for disability insurance can be a complicated and time-consuming process. If you need assistance applying for disability insurance benefits or your claim for benefits was denied, our team may be able to help.

We Help Injured Individuals Who Are Denied Benefits

Our disability law firm represented an emergency room physician with an own occupation disability plan. Northwestern Mutual, her insurance company, terminated her total disability benefits.

Our client suffered a serious leg injury. She could not easily move about the emergency room of a hospital. Pain and limited mobility caused her not to be able to safely treat patients. Northwestern Mutual agreed she was disabled from working as an ER doctor and approved her total disability claim.

She continued having pain and limited ability to move around after having medical treatment. When she did not return to work, Northwestern Mutual terminated her disability benefits. Northwestern Mutual stated she must be unable to perform “all” her job duties to be considered totally disabled. It decided she was able to perform duties that did not require her standing on her feet.

However, the disability insurance policy did not define total disability to mean she cannot do “all” duties. Total disability in the policy means she cannot do the “important duties” of her own occupation.

Our law firm argued that Northwestern Mutual was misapplying the definition of total disability. An emergency room doctor that could not move around the ER room or respond to a code blue emergency cannot do the important duties of her occupation. She is totally disabled under the disability insurance policy. We argued that the safety of patients would also be at risk. We gave examples of how patients might actually die if she is the ER room doctor on a shift at the hospital.

To support her total disability, our law firm got the medical opinions of our client’s doctors. Her doctors explained that she would experience more pain if she had to stand on her feet at the hospital. Their opinion was she could not work as an emergency room doctor.

After reviewing our arguments, Northwestern Mutual approved her total disability benefits again. We were successful in avoiding a lawsuit by convincing Northwestern Mutual that the termination of her disability benefits was unlawful.

Because each client’s case is unique and has different facts, results similar to those in other clients’ cases are not guaranteed.