From years of education and student loans to years of building a reputation—and a thriving business—in their field, physicians invest a lot of their time and money into their careers. The average annual cost of attending medical school is more than $34,000 and total medical student expenses amount to around $800,000, including lost opportunity earnings during the years a doctor is obtaining his or her education.
An investment like theirs makes sense when you realize that the average annual doctor’s salary is more than $224,000 and continues to rise. Often, doctors will protect that investment through individual and group long-term disability coverage. Read on for more information about the types of insurance coverage, the benefits a long-term disability policy can provide, and how to protect your legal right to this coverage.
What Individual and Group Long-Term Disability Insurance Covers
An injury or illness that renders a physician unable to perform the important duties of the occupation for an extended time can quickly lay waste to the investment of time and money. Individual and group long-term disability insurance protect that investment by paying a portion of the physician’s income—typically 50, 60 or 66 2/3 percent of their monthly earnings while he or she recovers. Most claims against long-term disability policies have nothing to do with an injury or illness caused on the job.
In fact, themost common reasons for filing a claim for individual and group long-term disability benefits include:
- Neck and back pain
- Muscle, tendon and arthritic disorders
- Disorders in the foot, ankle, or hands
Most people with long-term disability policies get those policies through their employers. However, individual long-term disability insurance is available to physicians through an agent or broker. Many policies will continue to pay out until the claimant reaches the age of 65 or normal retirement age.
The cost you can expect to pay for your policy depends on:
- Smoking status
The insured’s riders may also increase the cost of policy premiums. Common riders include:
- Occupation specific riders that pay a monthly benefit even if the physician can do some other work for gain or profit.
- An enhanced partial disability rider that provides payments if the individual is partially disabled and has a 15-20% drop in earnings directly caused by the sickness or injury.
- A cost of living rider (COLA), which increases the benefits the insured is eligible to receive a minimum of 3 percent annually to account for increases to cost of living.
- A future increase rider, which allows the insured to increase his or her coverage at a later time without having to go through the medical application process again. If the insured has increased earnings and decreasing health history, he or she can still qualify for increased monthly benefits.
Group Long-Term Disability
Many employers provide their employees with different types of group disability insurance coverage. Short-term disability coverage is provided for injuries or illnesses that are not expected to last for long, usually 7 days to 26 weeks. This coverage comes with a payout that begins shortly after the onset of the disabling injury or illness and generally lasts for less than a year.
If the employee is still unable to perform the important duties of their occupation once these short-term benefits expire, the employee generally can seamlessly access group long-term disability benefits. Group long-term disability policies are generally affordable to maintain, particularly since the employer may subsidize the premiums that the employee pays for the coverage. Employees may not need to undergo a pre-insurance medical screening before acceptance for group long-term disability insurance coverage as underwriting is minimal.
Unfortunately, these group policies do not provide the legal rights or consumer protections that individual policies do.
While workers’ compensation insurance is generally provided after a work-related illness or injury, group long-term disability coverage provides benefits to workers even if the injury or illness was acquired outside of their normal scope of employment. One downside to the group policy is that if you leave your job, you generally can’t take your long-term coverage with you.
Group long-term disability benefits are also governed by the federal government through the Employee Retirement Income Security Act (ERISA). ERISA was established in 1974 to regulate employee benefit plans. The various employee benefit plans—including group disability insurance, retirement, and health plans—that ERISA governs cover around 141 million workers and include more than $7.6 trillion in assets.
If your insurer wrongfully denies your valid ERISA claim, you must first, timely and comprehensively exhaust your group long-term disability insurance provider’s internal administrative appeals process before pursuing litigation in federal court.
Common Mistakes Made When Filing an ERISA Claim
Fatal mistakes are easy to make during your group long-term insurance policy’s complex claim application process. They can result in the wrongful delay, denial, or termination of your valid claim.
Some common mistakes include:
- Missing strict and unforgiving claim, proof of loss or administrative appeal deadlines. You must file your claim promptly after the date of your disability, to meet your policys’ proof of loss conditions. If you miss this deadline, you could lose your ability to obtain group long-term disability benefits.
- Assuming you have enough medical, vocational, occupational and financial evidence to support your claim, based solely on your employer’s determination that you are too sick or injured to perform the important duties of your occupation or relying only on information provided by your human resources department about filing a claim. Insurance companies decide which group long-term disability benefits they will pay based on their own policies, definitions and exclusions not the employer’s policies. Have an award-winning group long-term disability insurance lawyer at DarrasLaw check your policy provisions to know whether your disability will be covered. We offer a totally free policy review, claim form help and claim analysis.
- Providing only the documents given by the group long-term disability insurance company as evidence. Your group long-term disability insurer may provide you with an attending physician statement for your doctor to fill out regarding your illness or injury. However, you should talk to your treating doctor about writing a more substantial report for you—even at extra cost—that details how your injury or illness prevents you from performing the substantial and material requirements for your occupation, as the documents provided by your group long-term disability insurance company may not allow for detailed information they require to decide in your favor. The long-term disability attorneys at DarrasLaw can help you and your treating doctors to present the proper medical and occupational evidence to your disability carrier.
- Performing activities that are inconsistent with your restrictions and limitations by people with your illness or injury. Be careful what you do while you’re waiting for a decision on your claim or even after your claim is initially approved. If your group long-term disability insurance company discovers that you are engaging in activities that are inconsistent with your condition, they can use that information against you. This includes photos and information you post on social media as well as stories and information you offer to coworkers about the activities you’re involved in while you are too injured or ill to perform the important duties of your occupation. Beware of Pinterest, LinkedIn, Facebook and other social media postings even if you believe your activity is innocuous.
- Relying on advice from group long-term insurance company lawyers when filing for Social Security benefits. It’s not unusual for an individual filing a claim against group long-term disability to apply for Social Security benefits, or for your group long-term insurance company to encourage you to do so. Your group long-term disability insurance company may even offer the use of attorneys they recommend in applying for Social Security. Remember that the insurance company’s attorney doesn’t work for you—he or she works for the insurance company. Don’t feel surprised if he or she guides you to make decisions that will later make it harder for you to receive benefits from your group long-term disability claim.
Call a top-rated group disability insurance lawyer at DarrasLaw today, before you make a fatal claim application error or mistaken claim submission.
Individual Long-Term Disability Insurance
Those who want to take their long-term disability policy from one job to another generally desire an individual long-term disability policy. Attractive features of an individual policy include more coverage options. Individual policies may provide benefits if you are unable to perform the important duties of your own occupation specifically, even if you could earn money in any occupation.
Individual policies may require a medical exam as well as a limit on pre-existing conditions as a part of the policy application process. This information is used to determine the premium that the policy will require the individual to pay to maintain the coverage. These policies, which are tailored to suit the specific needs of the insured, generally cost more than a group policy would, but provide rich consumer safeguards including discovery and trial by jury.
You do, however, get many more consumer protections and legal rights under an individual long-term disability policy than ERISA affords you. You do not, in many cases, need to undergo an administrative appeal with your individual long-term disability insurance company before going to court over a wrongful delay, denial, or termination of benefits. You may also depending on where you live be entitled to attorney fees, emotional distress damages, extra contractual damages and punishment damages.
Business Overhead Expense (BOE) Insurance is a type of insurance coverage that business owners can purchase that pays the business overhead expenses, including day-to-day expenses like employee salaries, monthly gas, electric, rent, mortgage, and taxes.
You can purchase BOE as a standalone policy or in conjunction with a disability policy for complete coverage of the income you lose due to disability as well as the overhead expenses associated with running your practice.
BOE policies are generally available to individuals as private plans, not groups. This means that they’re not generally subject to federal ERISA laws.
BOE differs from other types of disability insurance in that the benefits only last up 12, 18, or 24 months in most cases, while other forms of disability insurance can provide benefits up to the age of 65 or normal retirement age. Insurance carriers tend to evaluate BOE policy claims based on what pre-disability salaries and overhead expenses were regularly paid.
To file a claim on your BOE policy, your disability must be severe enough to render you unable to perform the material aspects of your occupation and you must receive the most appropriate treatment for your disability from a physician. Like other types of income protection disability insurance, you may need to wait 30, 60 or 90—days before you can begin receiving benefits.
When searching for BOE coverage, you will find that some policies pay 100 percent of your overhead expenses, up to the maximum monthly benefit amount. In addition, because not all months produce the same amount of expenses, most BOE policies will allow you to roll over unused monthly benefits and apply them to the next month’s expenses until the policy benefits are exhausted.
Your BOE policy is generally “guaranteed renewable,” which means that your insurer is not permitted to modify or cancel your policy as long as you keep timely paying your premiums. Many BOE policies also provide partial benefit payments for those who are only partially disabled, known as residual disability benefits, as well as recovery benefits for those who need help with the cost of rehabilitation from injuries or illnesses. These residual benefits maybe available only after the insured has been totally disabled and often are limited to 30, 60 or 90 days.
Your policy may also provide presumptive disability benefits if your treating doctor believes you cannot ever recover from your injury or illness. Examples of injuries or illnesses that may give rise to the need for presumptive disability benefits include the loss of a limb or a bodily function such as eyesight or hearing.
The federal or state IRS may tax your BOE benefits as income, but allow you to deduct your premiums. For tax-related questions regarding your BOE policy and benefits, you should consult an experienced tax professional.
What BOE Generally Covers
- Payroll, employer contributions to employee benefits, payroll taxes, and in some cases the salary of a substitute employee hired to take over your work responsibilities during your disability.
- Office expenses, including utilities, equipment, and custodial services.
- The maintenance of equipment purchased before you filed your claim.
- Licensing fees and professional trade dues.
- Rent, mortgage, and property taxes associated with your business’s location.
- Insurance premiums for your other policies, including your property and liability insurance, as well as the group life and group disability policies of your employees.
What BOE Does Not Cover
- Income or profits for you or anyone else who shares in your business expenses.
- The income and profits of your relatives whom you employed for less than 60 days before you filed your business overhead disability claim.
- Costs covered by other sources or policies.
- Office space additions or renovations, including the provision of new office furniture.
Call Our Top-Rated Long-term Disability Insurance Lawyers Today
If your individual or group long-term disability benefits were wrongfully delayed, denied, or terminated, DarrasLaw’s award-winning lawyers can help you understand your legal options. Unlike many disability insurance law firms that require upfront payments and bill by the hour, DarrasLaw works on a contingency fee basis—we only recover a percentage of any settlement or judgment we help our clients recover, plus costs.
We also can help our clients with services that can include:
- Identifying the reason for your wrongful long-term disability insurance claim denial.
- The timely filing of an administrative appeal in your group long-term disability insurance case.
- Identifying the convincing and objective medical records and evidence you can use during your administrative appeal or file your federal ERISA lawsuit.
- Protecting you against medical and vocational experts whom your insurance company hired, and who may lack the proper training or specialization to properly and fairly evaluate your disability.
- The filing of individual lawsuit to make your insurance company pays the long-term disability benefits it owes you.
Frank N. Darras and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits worldwide. His lawyers and staff at DarrasLaw have more than 100 years of cumulative litigation and claim experience fighting for wrongfully delayed, denied, or terminated insurance benefits. We would love to hear from you about your case.
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“I have personal knowledge of and experience working with Mr Darras and his law firm. His compassion and professionalism towards his clients as well as the opposite party is unparalleled. I cannot recommend him highly enough.”
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For a free case evaluation and free policy review, call a top-rated individual or group long-term disability insurance lawyer at DarrasLaw today at 800-458-4577 or email us using our online contact form.