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ERISA Law

Long-Term Disability (LTD) Claims for Brain Surgeons

March 19, 2022
Long-Term Disability (LTD) Claims for Brain Surgeons

Medical professions are demanding jobs.  This is especially true when you are a brain surgeon.  Brain surgeons, also known as neurosurgeons, are some of the most highly trained and specialized medical professionals.  Over a decade’s worth of schooling and training is necessary to become one, so the prospect of not being able to work because of a medical condition can be hard to accept.

When brain surgeons develop a medical condition that negatively impacts their ability to work, they should file a long-term disability (LTD) claim.  However, filing a claim and managing your own health is a complicated task.  This article will address a few of the questions you may have about your LTD claim.

How Can I Find Out More About My Long-Term Disability Coverage?

Before you can file a long-term disability claim, you must first determine what type of insurance coverage you have.  Usually, there are two ways in which an individual may obtain coverage.  They can receive coverage through a group policy as part of an employee benefit or as private coverage that they purchased directly from an insurance company.

If you believe you have employer-provided group insurance, you can ask your employer directly for your plan-governing documents.  If you believe you have a private policy, you can check your bank statements to see if you have made any premium payments to your insurance company.  You can request a copy of your private policy directly from the insurance company.

It is possible to have both types of coverage simultaneously, as an individual policy can supplement the group policy and vice versa.

Why Is It Important for Brain Surgeons to Read and Understand My Long-Term Disability Policy?

Your policy contains invaluable information that you must know when filing an initial claim.  The terms of your policy govern the requirements you must meet in order to receive an approval of your claim.  Therefore, it is important to read your policy thoroughly.  Your policy includes information such as the definition of disability, specific deadlines, the maximum benefit period, limitations of your policy, and more.

Long-Term Disability Insurance 101

Whether you currently need to use your long-term disability benefits or not, it is important to review your policy so you can be prepared.  It is unfortunate when many claimants do not proactively read their policy because this leads to surprises when the process begins.

Nonetheless, one of the most vital pieces of information located within your policy that you should be aware of is the definition of “disability.”

Definitions of Disability for Brain Surgeons

When you read your policy, you must pay special attention to the definition of disability located therein.  The definition will tell you the level of impairment you must meet (and subsequently prove) to receive your benefits.  When you know the level of impairment that the insurance company is looking for, you can provide the right evidence to support your claim and prove your entitlement to benefits.

Long-Term Disability Insurance: Definition of Disability

Typically, you will find one of two definitions in your long-term disability policy.  While the specific wording of either definition may vary depending on your insurance company, they mean the same general thing.  You will see either an “own occupation” definition of disability or an “any occupation” definition.

The own occupation definition of disability focuses on whether you can perform the duties of your specific job, i.e., your “own” job.  This means that if you develop a condition that prevents you from carrying out the duties of a brain surgeon then your policy would consider you disabled.

The any occupation definition of disability focuses on whether you can perform the duties of any job whatsoever, regardless of its correlation to your job as a surgeon.  Therefore, if you had a condition that causes numbness in your fingers, thereby prohibiting you from conducting surgery, you could still receive a denial of your claim; a condition wherein your fingers are numb would not prevent you from teaching or performing some other sedentary job, which would not meet the “any occupation” definition.

Establishing You Meet Your Definition of Disability

As mentioned, an important reason for reading your long-term disability policy is to ensure you know the evidence you need.  The right evidence will prove you meet your policy’s definition of disability.

Long-Term Disability and Vocational Evidence

If your long-term disability coverage is an employer-provided benefit, then it is likely governed by ERISA.  This means that there are many strict deadlines.  Moreover, ERISA dictates that you may not submit new evidence after the appeal stage (should the insurance company deny your initial claim).  Therefore, it is important to get the right evidence as soon as you can to avoid any missteps.

Medical records are the most common form of evidence that you gather but are rarely sufficient by themselves to prove a claim.

When you are a brain surgeon filing a long-term disability claim, it is important to provide ample supplemental evidence to prove why you can no longer carry out the duties of your job.  This supplemental evidence can include specialized reports by treating physicians; witness statements by family members, friends, and coworkers; or evaluations conducted by outside experts.

It is important to remember that insurance companies prefer to avoid paying claims whenever possible, so supplying sufficient evidence is key.

Establishing the Duties of Your Occupation

One of the biggest issues you will face is establishing the duties of your occupation.  Unfortunately, insurance companies routinely use outdated definitions of occupations when arguing against claims.  The Dictionary of Occupational Titles, (fourth edition), which was last edited in 1991, is still the prevailing reference book used by insurance companies across the country.

This reference book is also not the most detailed, either.  In fact, most of the job descriptions barely describe the true scope of the various occupations contained within it.  Another resource, the O*Net Database, is sometimes used and is more up to date, but it is still important to fully establish the actual day-to-day duties of your job yourself.

Brain surgeons have an emotionally and physically taxing job.  Therefore, there are myriad conditions that could prevent brain surgeons from adequately carrying out their job; a general description of what a surgeon does will not reflect the high stress and emotional strain that comes from such a job.  When you can illustrate these aspects of your job, you help strengthen your claim.

Proving Your Condition Meets the Definition of Disability

There are many conditions that can render brain surgeons disabled.  For example, if a brain surgeon suffers from insomnia, their cognitive abilities suffer.  Insomnia prevents a person from getting adequate sleep, which can add stress and anxiety to their life.  A brain surgeon’s profession is already stressful; and when you pair this with the tiredness that comes with insomnia, a brain surgeon may find it impossible to do their job.  A brain surgeon cannot risk operating while tired and stressed because it could cost a patient’s life.

There are many physical conditions that could cause a brain surgeon to be unable to carry out the duties of their job.  The hands of a surgeon are among their most important tools.  Many medical issues can happen that can affect their ability to use their hands.  For example, a wrist problem, arm issue, or shoulder issue can make it impossible for the surgeon to use their hands.  Moreover, there are long hours of standing associated with surgery.  Any issue with their back or legs could inhibit their ability to perform a surgery.

As mentioned earlier, supplemental evidence is necessary to prove your condition meets the definition of disability.  Demanding jobs like a brain surgeon, however, do not need an extensive condition to qualify for disability.  These demanding occupations often cannot be sustained with even minor mental or physical conditions.

What Other Benefits May Be Available to Brain Surgeons?

It is important for brain surgeons to remain cognizant of all the benefit options available to them.  In addition to long-term disability benefits, you may also be eligible for Social Security Disability Insurance (SSDI).

How Does Social Security Disability Work With Long-Term Disability?

SSDI has its own set of requirements and rules, but if you are unable to perform your job, or your disability will last a year or more, you are usually eligible.

However, because there is a separate set of requirements and rules governing SSDI benefits, the definition of disability may differ between policies.  For example, if you meet the definition of disability under your LTD policy, that does not guarantee that you shall meet the definition listed under your SSDI policy.  Therefore, it is possible you are disabled under one but not the other, and vice versa.

What Do I Do If My Long-Term Disability Claim Is Denied?

If the insurance company denies your long-term disability claim, you have the right to file an appeal.  If your policy is ERISA-governed, this is a crucial stage because it is the last time you can submit new evidence.  Moreover, you have limited time to file the appeal.

If you received a denial of your initial claim, you should consider contacting a long-term disability lawyer.  A long-term disability lawyer can help navigate you through the appeal stage and will know the right evidence to submit to get your benefits approved.

Call Chisholm Chisholm & Kilpatrick Today for a Free Consultation Regarding Your Claim

Whether you need help with your initial claim, filing an appeal, or court litigation, Chisholm Chisholm & Kilpatrick can help you.  Our legal team is dedicated to fighting for your LTD benefits.  As a brain surgeon, it is important that your disability claim is handled fairly by the insurance companies, and CCK will ensure that it is.

If you need assistance with your long-term disability claim, regardless of where in the process you are, you can contact us today at (800) 544-9144 for a free consultation with a member of our team and see how we can help.

Long-term Disability Claims Process Overview