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Long-Term Disability For Doctors & Nurses During COVID-19

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Mason Waring : Hi. My name is Mason Waring. I’m an attorney and partner at Chisholm Chisholm and Kilpatrick. I’m here today with my colleague Leah Small, who’s a CCK attorney. We represent people on long-term disability, life insurance, health insurance, ERISA, and Non-ERISA insurance claims. And we’re here to talk specifically about doctors and nurses’ long term disability claims related to Covid-19. A few days ago, we did a video generally about Covid-19 and long-term disability claims. We’ve received a number of inquiries specific to doctors and nurses. They’re really on the front lines of this pandemic. And so, we thought it would be helpful to put together a presentation really focused on those medical professionals and some of the things that they’re dealing with and some of the maybe unique or common things that are found in their long-term disability policies. If you have questions or you want to find out if your claim is something that we can assist with, please feel free to reach out to us. Our number is 401-331-6300. It doesn’t cost anything to talk to us, to see if we can help. Hopefully, this video has some good information that helps you with your claims. So Leah, ready to get started?

Leah Small: Absolutely.

Mason: Great. So, what types of conditions are we seeing doctors and nurses struggle with due to Covid-19?

Leah: So, we touched upon this in our previous video but a lot of the claims we are seeing are doctors and nurses who have a health condition, which puts them at high risk for either serious Covid-19 symptoms or even death and obviously as you said, they’re on the front line, so they’re at a potentially very high risk for exposure to this virus as well. We’re also seeing an uptick in mental health conditions such as depression and anxiety among doctors and nurses. It can be either pre-existing condition they are managing up until this pandemic hit or a newly developed mental health condition. It’s typically the result of the stress and demands they’re under. They’re working very long hours. They’re dealing with a high number of patients. They are at a high risk that they could get sick, that they could bring the virus home and a family member could get sick. And they’re both dealing with a lot of sick people, a lot of death and it’s just a very high stress environment for them.

Mason: And so for the pre-existing condition, the underlying health conditions that leave people susceptible, that will leave a doctor susceptible to serious Covid-19 symptoms or even death, immunocompromised people, if they’ve gone through cancer treatment or someone with significant heart disease. So we’ve seen those types of- the list goes on. Serious, underlying, health conditions where they really need to watch out for their exposure to Covid-19. Let’s focus a little bit on the mental illness because the sickness and injuries that medical professionals are enduring related to the trauma they’re dealing with is a real problem. But before we jump into that, I know medical professionals; nurses, doctors often have short-term disability and long-term disability coverage. You talk a little bit about the difference with those.

Leah: Sure. So, short term disability is just what it sounds like. It provides us bill of benefits for a short period of time. The time period varies, but it’s often 90 to 180 days. Not all employers offer short-term disability. If you work in a state that has governmental disability, like here in Rhode Island, we have temporary disability insurance. You may not have short term disability insurance coverage, but you have benefits available to you through another avenue. Typically, short-term disability is meant to cover the gap before long term disability benefits begin. Long term disability is disability meant for a longer period of time. Oftentimes, if you do remain disabled you can get long term disability benefits up until age 65 or even longer, again, depends on your coverage though. There may be limitations and so forth, but it’s a much longer period of time. Typically, there’s a waiting period before the long-term benefits begin. And again, that’s typically the 90 to 180 days that short-term is supposed to cover.

Mason: So, if one of our viewers is now disabled. How do they find out what coverage they have?

Leah: So, you can get covered in a couple different ways. You could have purchased it yourself. If you did, you should have a policy. If you’re not sure, look at you know, your bills, your bank account. Have you been paying premiums to an insurance company? If you have, you can reach out to the insurance company to get a copy of your policy. A lot of people also get this coverage through their employer as a benefit. If you’re not sure, you can reach out to HR is normally a good place to reach out and ask them for any plan document leading to short-term or long-term disability coverage. And if you have it, they should be able to provide that to you.

Mason: Thanks Leah. Many doctors and nurses have long-term disability coverage that we’ll call it ‘own occupation coverage’, at least for the initial period of disability. Could you explain what that is?

Leah: Sure. So, own occupation coverage means that you’re entitled to disability benefits if you are unable to perform your own occupation due to your health condition. Obviously, it’s a very broad description. The specific definition of disability will vary policy to policy. So, whether, sometimes the definition disability asks, can you perform any of your duties? It maybe can you perform some of them just not a full-time basis. So, it really varies, but generally that covers you if you’re unable to perform your own occupation. For medical professionals, there’s an added layer to that usually. Most of disability policies from medical professionals ask more specifically, what’s your specialty or your board certification is? So, when they’re defining what-

Mason: In physicians particularly, right?

Leah: Right. And so once defining or looking at what is your own occupation? It’ll take into account as we said, your specialty, your board certification. So for example, if we have a claimant who is an orthopedic surgeon, the question won’t be can he perform the duties of a doctor generally, it’s going to be can you perform the duties of an orthopedic surgeon specifically. Similarly, we have claimants who are emergency room physicians and that is much different than a primary care physician in a medical office. And so own coverage will take that into account when determining whether their health condition prevents them performing their own occupation.

Mason: And with respect to Covid-19, obviously an emergency room doctor or nurse won’t be able to shield themselves from Covid-19 the way you know, maybe a doctor working in a primary care practice could. Maybe not. And so that’s another thing to be taken to consideration and is somewhat uncharted territory here dealing with a pandemic where we’re at. So, it’s so widespread.

Leah: One other thing I’ll just add to that, to keep in mind. We do have some doctors who may be board certified or have a specialty but they haven’t been practicing in that specialty recently. So just something to keep an eye out for some policies will just say whatever your specialty or board certification is. That’s your own occupation. But others require you to have actually been performing in that specialty or certification prior to your disability. So if you are certified as a surgeon, but you haven’t been performing surgery in the last year or so, your own occupation may no longer be surgeon for purposes of your disability coverage. So just something to keep in mind and just emphasizes that you need to read your Disability Policy, understand where you’re coverage is.

Mason: The policies vary greatly, you know, one to the other. And you may find out that you have coverage you didn’t think you had if you’re disabled and unable to work and then you may find out that your coverage isn’t as protective as you thought it was. But it is really important to read your policy and understand it. Let’s talk now about the mental health conditions. If someone has a new mental health condition or injury as a result of the Covid-19 pandemic, what should they keep in mind?

Leah: So first thing, for both your health, their health, number one, but also if they feel they need to file a disability claim, they need to be in treatment for the condition and needs to be appropriate for their condition. So that’s absolutely number one that you take care themselves through treatment. But also for the claim they’ll need to be in treatment. They’ll also need to demonstrate that their condition, reaches a severity that it prevents them from performing their own occupation. So just because you have a diagnosis doesn’t automatically mean you’ll be entitled to disability benefits.

Mason: What if a medical professional is now suffering an exacerbation of an existing mental health condition?

Leah: So, again, same thing, they have to be in treatment. They’re likely going to need to demonstrate a worsening of their symptoms. The insurance companies in these situations likely to ask were you working with this condition before? So why can’t you work with it now?

Mason: So, we’ve been getting some nuts and bolts types of questions about filing long-term disability claims, making the initial claims. What are some things that our viewers should consider?

Leah: So, first up and we touched on this, figure out if you have disability coverage. Again, you may have purchased it yourself. And if you’re not sure or you can’t locate disability policy, look at your bank statements, see if you’ve been paying to an insurance company and you can request a copy of any coverage you have from them. If you may have gotten it through your employer and again, you can go to HR and ask for the documents relating to any short-term or long-term disability coverage they might have. If you determine that you do have disability coverage, first step is reading the policy, plan documents, determine what coverage you have exactly. One of the most important things is understanding what definition of disability you’re going to need to meet. We touched upon the own occupation definition, which is what a lot of doctors and nurses have coverage for, which asks, you’re disabled, you can’t perform your own occupation any longer due to your health condition. But some policies are not that protective, some are just any occupation policies which provides coverage if you’re unable to perform any occupation. Those are obviously a harder definition usually to meet, so it’s important for you to understand what your definition is. So, you know what you need to prove in order to be entitled to benefits. And, so generally, the definition of disability and the severity of your condition, is what’s going to govern, generally, whether you’re entitled to benefits. So as we said, look for does your policy take into account your board specialty? For your board certification? That’s important to know. It’s possible in some circumstances, if you have, for example, in any occupation policy that you’re totally disabled from your own occupation. But if you can go and do something else and you may not be entitled to benefits. So it’s really important to understand what your definition disability is.

Mason: Leah, if I could just add to that. With own occupation, if a physician maybe couldn’t work in a clinical setting due to the Covid-19 pandemic, but they were able to do an online teaching or telemed type work, if it were lower-paying, if they suffered an income loss as a result of that, your policy may provide you partial disability benefits to cover, to make up some of that income gap.

Leah: Absolutely. And that again, emphasize why it’s so important to get a copy of your policy and read it to understand what you have available to you. Our advice generally is, if in doubt, file claim. It’s better to get a claim in than not file a claim and delay and then risk that you might be out of luck if you wait too long. And one thing we see a lot, especially with hard-working professionals like doctors and nurses, is that they want to go back to work. So they may say, I’m not going to file a claim, again, maybe because they’re ashamed of their condition or, again, they want to go back to work. They don’t think it’s going to last very long. So they say I’m not going to do it. I’m just going to get healthy and go back. And especially in the environment were in, where they’re on the front line doing such extreme important work. A lot of you may feel, they need to power through and just keep pushing. But it’s important for them to do what’s best for themselves and for their health. And they’re dealing with patients and you do what’s best for their patients. And as we said, there may be deadlines in their policies for filing claims. They should not delay.

Mason: So, right. So, be informed and make decisions based on facts. What your health really is, what your risk level is, what your ability is. And get all the information you can and make the appropriate decision. Great. Thanks, Leah. Give me final thoughts or takeaways for our viewers.

Leah: It’s generally, if you are a medical professional, like a doctor or a nurse who’s become unable to perform your occupation, whether it’s because of this was a health condition that places you at high risk or as we focus on the mental health conditions that may have been exacerbated or developed in response to this pandemic, they may be able to file a disability claim. And they shouldn’t let either fear or shame or their desire to return to work prevent them from doing that. The first step should be read in their policy, figure out what level of coverage they have. It’s also important to read because there might be limitations or exclusions in the policies, so figure out what those are, and just get a claim in. And if they need assistance getting a claim in or they filed a claim and the insurance company is giving them problems, they can consider contacting attorney like CCK, who focuses on these types of disability claims for assistance.

Mason: Thanks, Leah. Hopefully, this video helped many of you try to address some of the frequently asked questions that we’re receiving relative to medical professionals and Covid-19-related disability. If you have questions, if you want to see if we can help. It doesn’t cost anything to talk with us to see if we can help. So, please please reach out 401-331-6300. Take care of yourselves and be well. Thanks very much.