Long Term Disability Law Blog
When OB-GYN doctors apply for long term disability (LTD) benefits, they generally do not realize they are dealing with a claims examiner who really has no idea of what the daily practice entails. This is true even if the examiner is a female who thinks she knows what duties are involved in such a practice.
The examiner needs to realize the job of an OB-GYN is not 9 to 5. Babies are born at unpredictable times so the doctor must be available 24/7. It is physically, mentally, and emotionally challenged. They have mothers and babies lives in their hands. Some surgeries are scheduled. Others are emergencies. It is important to make the disability claims examiner understand the demands of the job.
The disability insurance company will carefully scrutinize the OB-GYN’s CPT procedure reports
The insurance company will ask for CPT codes going back one or two years prior to the date the doctor claims as the date of becoming disabled. The company is checking to see what procedures the doctor was doing on a daily basis prior to the disability date.
The company will look to see how many babies were being delivered in a week or a month. Is the doctor performing colposcopies or biopsies? What other tasks did the doctor perform in the past that have decreased in numbers?
The company is very strict and will carefully scrutinize these reports to confirm that the doctor has, in fact, decreased his practice and is not earning the income he or she previously earned.
A total versus residual disability analysis is always an issue for an OB-GYN that works with a disability
Depending on the insurance carrier, or type of policy, an OB-GYN may be able to cut back on the practice. Perhaps give up surgery but only deliver babies, but the change in the practice has resulted in a reduction of revenue. The company will say the doctor is not totally disabled because he/she can still perform some material duties of the occupation.
It may seem tempting to agree to residual disability. Doctors often want to keep practicing some of the time if they can. But generally, accepting residual disability means sacrificing a lifetime total disability benefit.
A documented history of medical treatment is essential for disability benefit approval
Key to approval of the LTD benefit claim is to have a history of documented medical treatment. This is sometimes a problem for doctors who want to keep practicing medicine and don’t want a record of their medical problems. They treat informally with colleagues or friends so when they finally realize they need to stop practicing, their own medical records are lacking in documentation.
While there is nothing that forbids seeking treatment from friends, that treatment must be documented in the progress notes. Test results must be included. According to the insurance company, if it isn’t documented, then it didn’t happen.
We tell our clients to be sure they are getting formal treatment that is documented in medical records for several months prior to filing their disability claims.
The disability companies use video surveillance, credit reports, and social media to try to make an OBGYN look like a liar
Disability companies use all available methods in their attempt to deny the OB-GYN’s disability claim. A social media post that seems innocent may be just the weapon the company is looking for to say, “See what he/she is doing here? That is not consistent with the claimant’s statement of disability.” All they are looking for is one instance where they can show the doctor made inconsistent statements so they can attack the OB-GYN’s credibility.
Doctors should be scrupulously honest and carry out that honesty in their daily activities. Otherwise, they may find themselves trying to explain away what appears to be a compromising situation.
No matter where you are in the long term disability claim process, you can benefit from a team of attorneys with extensive experience in disability insurance law. Give Dell Disability Lawyers a call today to schedule your FREE consultation.