Short and Long Term Disability for Surgeons
- Matthew Maddox
- 22 hours ago
- 12 min read
Surgeons face unique challenges in their profession, with high demands that can lead to physical and mental health issues impacting their ability to work. The precise nature of their job demands, combined with long hours and stressful conditions, heightens their risk of conditions that could prematurely end a surgical career. If you are a surgeon, understanding the nuances of short and long term disability insurance is essential for protecting your financial future.
In this article, we’ll explain what surgeons need to know about short and long term disability insurance, outlining effective strategies for documenting your claim and highlighting common pitfalls to avoid that lead to benefit denial.
What Should Surgeons Know About Disability Insurance Policies?
Given the high level of skill and training required in their profession, coupled with the significant investment in their career development, surgeons face considerable financial risks if a disability curtails their ability to work. Comprehensive disability insurance is not just a safety net but a critical component of a surgeon’s financial planning, protecting against the loss of income that can arise from unforeseen health issues.
It's important to first understand the difference between short and long term disability insurance. Short term disability typically covers a portion of your income for a brief period, such as a few months, helping you manage financial obligations while recovering from a temporary condition. In contrast, long term disability provides more extended financial support, potentially lasting years or even until retirement, which is vital for conditions that permanently impair your ability to perform surgeries.
When exploring disability insurance options, surgeons should meticulously assess various policy features to ensure they secure the coverage that best protects their income and career, including:
Group vs. Individual Policies: Group policies are typically provided through employers or professional associations and may offer more affordable premiums due to the risk being spread across a group. However, these policies often come with more restrictive terms and may not provide coverage if you switch employers. Individual policies, while generally more expensive, can be customized to suit specific needs and remain in force regardless of job changes, offering surgeons a consistent and reliable safety net.
Own Occupation vs. Any Occupation: Surgeons are highly advised to select “own occupation” insurance policies. These policies provide benefits if you are unable to perform the specific tasks of your surgical specialty due to disability, offering more targeted protection compared to “any occupation” policies. The latter only offer benefits if you’re unable to perform any job for which you are qualified by education, training, or experience, which might not be ideal for highly specialized professionals like surgeons.
Benefit Periods: The length of time benefits are paid out varies by policy. Some policies provide short-term benefits for a few months to a year, while others offer long-term benefits that can last until retirement age or the policyholder is no longer disabled. Surgeons should consider their financial needs, potential career longevity, and the nature of their specialty when deciding on the appropriate benefit period.
Residual or Partial Disability Coverage: This feature is particularly beneficial for surgeons who may not be fully disabled but whose earning capacity is diminished due to their disability. It allows for the collection of a portion of the disability benefit proportional to the loss of income if you are only able to work part-time or in a reduced capacity.
Cost of Living Adjustments (“COLA”): Inflation can erode the value of disability benefits over time. COLA riders adjust the benefit amount annually based on inflation rates, helping maintain the purchasing power of the benefits received, which is particularly important for benefits that are expected to be paid over long periods.
Policy Exclusions and Limitations: It’s crucial to understand what the policy does not cover. Common exclusions include disabilities resulting from acts of war, self-inflicted injuries, or specific conditions like drug and alcohol use. Additionally, some policies limit the benefits payable for conditions like mental health disorders, which are prevalent in surgical professions.
Portability: For surgeons moving between practices or working in less permanent roles, it’s vital to ensure that the disability insurance is portable. This means the policy remains in effect regardless of changes in your employment status or location, providing continuous protection.
Each policy feature has significant implications for coverage and cost, making it crucial for surgeons to carefully evaluate their options with these factors in mind. This thorough approach ensures that the chosen disability insurance policy provides robust and reliable financial protection tailored to the unique risks and needs of surgical professionals.
What Are the Most Common Reasons Surgeons File for Short Term and Long Term Disability?
Surgeons file for short term and long term disability for various reasons, often due to the physically demanding and high-stress nature of their profession.
Here are some of the most common causes:
Musculoskeletal Disorders: Repetitive strain injuries, back problems, and other musculoskeletal issues are prevalent among surgeons due to the long hours spent in surgery, often in ergonomically challenging positions. These conditions can lead to chronic pain and disability, making it difficult to perform surgical tasks.
Mental Health Issues: The high-pressure environment of surgical work can contribute to stress, burnout, anxiety, and depression. These mental health issues can impair a surgeon’s ability to function effectively in the operating room and manage the demands of their role.
Neurological Disorders: Conditions like Parkinson’s disease or other neurodegenerative disorders can affect a surgeon’s fine motor skills and cognitive functions, crucial for performing surgeries.
Cardiovascular Diseases: Heart diseases and hypertension can be exacerbated by the demanding nature of surgical work. The physical demands and stress can increase the risk of cardiovascular events, leading to potential disabilities.
Vision Impairments: Accurate vision is essential for surgeons. Any significant vision impairment, whether due to age-related issues, injury, or illness, can hinder their ability to perform surgeries safely and effectively.
Infectious Diseases: Surgeons are at a higher risk of exposure to infectious diseases, which can occasionally lead to serious health complications. These may include conditions like HIV, hepatitis, or severe infections that can result in temporary or permanent disability.
How Do Specific Surgical Specialties Impact Disability Risk and Claims?
The risk of disability and the nature of claims can vary significantly among surgical specialties, reflecting the unique demands and risks associated with each type of surgery.
Here’s how some specific surgical specialties impact disability risk and claims:
Orthopedic Surgery: Known for its physically demanding nature, orthopedic surgery often involves repetitive motions, heavy lifting, and long periods of standing. These physical demands can lead to musculoskeletal injuries, particularly in the back, neck, and hands, which are common reasons for disability claims in this specialty.
Neurosurgery: This specialty involves high levels of precision and can be extremely taxing mentally and physically. If neurosurgeons experience any level of impairment to their cognitive functions or fine motor skills, they may be unable to perform the material duties of their occupation.
Cardiothoracic Surgery: The prolonged duration of surgeries and the critical nature of the procedures contribute to both physical and psychological stress. Cardiothoracic surgeons may experience cardiovascular issues as a result of the demanding work environment and are also prone to fatigue-related disabilities.
General Surgery: General surgeons often face a broad range of risks due to the variety of procedures they perform. They can be exposed to infectious diseases more frequently than surgeons in more specialized fields, and the erratic hours and emergency nature of their work can lead to sleep disorders and chronic fatigue.
Plastic Surgery: While perhaps less physically demanding than other surgical specialties, plastic surgeons can still suffer from repetitive strain injuries, particularly in the hands and wrists. They may also deal with high levels of stress related to the aesthetic outcomes of their surgeries, impacting their mental health.
Obstetrics and Gynecology: Surgeons in this field often work unpredictable hours with a significant amount of emergency procedures, leading to sleep disturbances and high stress. They are also at risk for musculoskeletal injuries from procedures like childbirth assistance.
Each specialty’s distinct work environment and procedural demands influence the types of disabilities surgeons are most likely to encounter and thus the nature of the disability insurance claims they might file. Surgeons must consider these specialty-specific risks when selecting disability insurance to ensure adequate coverage for the most probable risks in their field.
How Can Surgeons Document Their Disability to Support Their Claims Effectively?
For surgeons filing disability claims, thorough and accurate documentation is crucial to establishing the legitimacy of their disability and securing the benefits they are entitled to.
Here are types of evidence surgeons can use to document their disability effectively:
Detailed Medical Records: Surgeons should ensure that all medical records related to their condition and symptoms are comprehensive and up-to-date. This includes records of initial diagnoses, treatment plans, medical interventions, and communications with healthcare providers. Regular updates from treating physicians that detail the progression or persistence of the condition are essential.
Specialist Evaluations: Since surgeons work in highly specialized fields, evaluations from specialists who understand the demands of surgical work are crucial. These specialists can provide detailed assessments that explain how the surgeon’s condition impairs their ability to perform specific surgical tasks.
Functional Capacity Evaluation (“FCE”): An FCE can be particularly useful as it assesses your capacity to perform work activities related to their job. For surgeons, this might include tests of dexterity, endurance, and other physical abilities essential for operating room tasks.
Personal Statements: Surgeons should also provide a personal statement as part of their claim documentation. This statement should detail how their condition affects their daily activities, both inside and outside of the workplace, highlighting the specific surgical tasks they are unable to perform.
Work History and Job Description: Documenting the specific requirements of their surgical specialty can help illustrate the impact of the disability. Detailed job descriptions, including the physical and cognitive demands of their roles, can be provided by the employer or from professional surgical associations.
Third-Party Observations: Statements from coworkers, operating room staff, and others who have observed your difficulties firsthand can provide additional perspectives on how the disability affects your professional performance.
Evidence of Treatment and Compliance: Surgeons should keep detailed records of all treatments and interventions they have undergone to manage their condition, including medications, physical therapy, and any adaptive technologies or aids. Evidence of compliance with treatment recommendations supports the claim that the disability is managed as well as possible yet remains disabling.
By assembling a comprehensive documentation package that includes medical evaluations, personal accounts, and occupational details, surgeons can effectively support their disability claims, demonstrating the genuine impact of their condition on their ability to practice surgery.
What Are the Most Common Reasons Insurance Companies Deny Surgeon Disability Claims?
Insurance companies may deny disability claims from surgeons for several common reasons, such as:
Insufficient Medical Evidence: One of the most frequent reasons for denial is the lack of sufficient medical evidence to substantiate the disability claim. Insurance companies require detailed and comprehensive medical records, specialist evaluations, and consistent documentation that clearly demonstrates the severity and impact of the condition on the surgeon’s ability to perform their duties.
Discrepancies in Documentation: If there are inconsistencies between the surgeon’s reported limitations and the observations noted in medical evaluations or seen in surveillance footage, insurers may question the validity of the claim. This also includes any inconsistencies found between what a surgeon reports and what they are documented doing in their personal life or on social media.
Not Meeting the Policy’s Definition of Disability: Each insurance policy has specific definitions of disability, and claims may be denied if the documentation does not convincingly show that the surgeon’s condition meets this definition. For surgeons, this often revolves around proving they are unable to perform the duties of their specific specialty rather than just any medical job.
Pre-existing Conditions: Claims can be denied if your insurance company determines that the disability stems from a pre-existing condition that was not disclosed at the time the policy was purchased, especially if there is a specific exclusion clause related to pre-existing conditions in the policy.
Failure to Follow Prescribed Treatment: If insurers believe that the surgeon has not followed prescribed treatments or medical advice, they may argue that the disability could have been mitigated or resolved. Compliance with treatment regimens is often a requirement for ongoing benefits.
Surveillance and Activity Checks: Insurance companies sometimes use private investigators to conduct surveillance on individuals claiming disability benefits. If surveillance footage shows the surgeon engaging in activities that contradict the limitations they claim to have, the insurer may deny the claim.
Lack of Objective Evidence: Especially relevant in cases involving conditions with subjective symptoms (like chronic pain or mental health issues), insurers may deny claims that do not include objective evidence like imaging tests or blood work that confirms the condition.
You can mitigate the risk of claim denial by ensuring that you fully understand their policy’s coverage and exclusions, maintain thorough and consistent medical records, and adhere strictly to prescribed treatment plans. It is always recommended that when filing a short or long term disability, you consult an attorney who specializes in disability insurance. They can provide an added layer of defense against potential denials and help substantiate your claim.
Can Surgeons Work in a Different Capacity While Receiving Disability Benefits?
Yes, surgeons can often work in a different capacity while receiving disability benefits, depending on the specifics of their insurance policy and the nature of their disability.
Here are the key considerations:
Policy Type and Definitions: The possibility of working in a different capacity while on disability depends heavily on the type of disability insurance policy and the definitions it employs. Policies categorized as “own occupation” allow for the payment of benefits if a surgeon is unable to perform the specific duties of their surgical practice, even if they are capable of working in another capacity. This means a surgeon could potentially take up a teaching role, research position, or administrative job in the medical field and still receive disability benefits.
Residual or Partial Disability Benefits: Some policies include residual or partial disability benefits, which are designed for situations where an individual can still work but their earnings capacity is diminished due to their disability. Under these benefits, a surgeon who can no longer perform surgeries due to physical limitations but can work part-time or in a less demanding role may receive a portion of their disability benefit proportional to the loss of income.
Benefit Adjustments: If a surgeon starts a new job or role that pays less than what they were earning as a full-time surgeon, the insurance company may adjust the disability benefits to account for the new income. The specifics of how benefits are adjusted are defined in the policy.
Reporting Requirements: Surgeons must adhere to strict reporting requirements stipulated by their disability insurance policy. This often includes informing the insurance company about any new employment and the income derived from it. Failure to report new work activity can lead to denial of claims or cessation of benefits.
Ultimately, the ability for a surgeon to work in a different capacity while receiving disability benefits hinges on the details of their insurance policy and their specific medical circumstances. Surgeons should review their policy closely and consult with an experienced disability attorney to understand the implications of working while receiving benefits.
How Can The Maddox Firm Prove My Short or Long Term Disability Claim?
At The Maddox Firm, we understand the complexities involved in proving short and long term disability claims for surgeons. Our experienced team is dedicated to navigating the specific challenges surgeons face during the process to ensure you receive the benefits you deserve.
Here are a few ways The Maddox Firm can help prove your short or long term disability claim:
We Examine Your Policy and Assess Your Claim: Our first step is to thoroughly review your disability insurance policy to understand the definitions and provisions. We assess your claim based on these parameters, focusing on the unique aspects of surgical practice and how your disability impacts your ability to perform those duties. This includes examining the “own occupation” clauses that are pivotal in determining eligibility for surgeons who may no longer be able to operate but could potentially work in other capacities within the medical field.
We Handle All Communications with Your Insurance Company: Communicating effectively with insurance companies can be daunting. We manage all correspondence on your behalf to ensure that your case is presented clearly and persuasively. Our team is skilled in articulating the specific demands of surgical work and how your condition impedes your ability to meet those demands, thereby avoiding common pitfalls that can lead to claim denials.
We Help You Obtain Evidence to Support Your Claim: The Maddox Firm collaborates with medical experts to document the extent of your disability, including detailed medical evaluations, such as Functional Capacity Evaluations or neuropsychological evaluations, that highlight how your condition limits your surgical capabilities. Additionally, we can refer you for an assessment with a vocational expert to make sure the demands of your occupation as a surgeon are fully reflected in your claim. We also gather testimonies from colleagues and other healthcare professionals who can attest to the precise nature of your surgical duties and the impact of your disability.
We Handle Appeals and Litigation: If your disability claim is initially denied, we are prepared to pursue appeals and, if necessary, litigation. We are committed to advocating for your rights through every stage of the legal process to secure the benefits you are entitled to.
A short term disability or long term disability claim can be a complicated process. If you need help during the claims process, with appealing a claim denial, or with litigating a final adverse short term or long term disability decision, The Maddox Firm can help. The experienced team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim. Our New Jersey and New York long term disability attorneys help clients nationwide.