For surgeons and other physicians, partial long-term disability benefits may seem like a good solution but the way the benefits are determined is flawed. Partial benefits are based on a formula and very soon after the claim is filed the formula starts to disintegrate and someone may wind up in a situation where, over time, the partial disability benefits are virtually nothing.
Partial disability benefits are often cut off at age 65 where total disability benefits are very often lifetime benefits. Sometimes insurance companies will review specific policies with a certain present value of future policy benefits and determine how they can best save money in the payment of a disability claim, even if the decisions is to pay the claim. Often, with a larger policy, the insurance company may send someone out to an “independent” medical examination, in other words, an insurance medical examination.
The company will have a nurse back at the home office of the insurance company read through the medical records and determine based on that, that there’s no disability. Or worse, they pay the claim for a while and then they’ll terminate the benefits somewhere down the line. Many disability cases are not easily discernible, the nature and the extent of the disability and its long term impact are not immediately measurable.
In California, Nevada, Arizona and some of the other western states, there really is no such thing as partial disability. The definition of total disability is such that there is no room for partial disability because in the policies, total disability is considered the inability to perform your important duties in a usual and customary manner. Partial disability will be the inability to perform some of your important duties in the usual and customary manner. It’s unclear how you can be unable to perform some of your important duties while you are not unable to perform your important duties.
It doesn’t say all of your important duties and obviously if a surgeon can’t operate normally regardless of whether he/she can still open the door to the operating room or still pick out a scalpel or assist in a surgery that person is going to be totally disabled, not partially disabled. That person always has the option to alter the medical practice by adding a component for physical rehabilitation for example or adding a pharmaceutical component as some of our clients have done but the option of remaining surgeon as before is completely gone. It remains that if that person can’t be the surgeon he/she was before and can’t do those exact things that a surgeon is required to do, there is a totally disability and an entitlement to total disability benefits. Unfortunately not everybody understands that, not all doctors understand that and more importantly not all insurance agents understand that.