You checked the box on your to-do list and got long term disability insurance during residency. You’ve paid the premium and increased your coverage when you could. But if you actually need to file a claim, do you know what happens next?
The disability insurance claims process can feel daunting, especially when you’re dealing with an illness or injury. Here is what every physician should know before they need to file.
1. The 90-day waiting period.
Every policy has an elimination period (usually 90 days). This is the waiting period between your disability date and your first paycheck. You’ll need 90 days of liquid savings (or a group policy that kicks in sooner) to bridge this gap.
2. The “Own Occupation” definition.
This is the reason some physician claims get denied. The definition of disability within your policy matters.
Any Occupation: Pays only if you cannot do any job. A surgeon with a bad back? The insurance company may say you can still teach or do admin, and your claim would be denied.
True Own-Occupation policy: Pays if you cannot do your specialty. Full benefits, even if you work another job. This is the definition generally recommended for physicians.
Step 3: Filing the Attending Physician’s Statement (APS)
When you file a claim, the insurance carrier sends a form to your treating physician and asks specific questions about: objective findings (MRI, EMG, labs), subjective complaints (pain, fatigue, cognitive fog), and functional limitations.
Many doctors aren’t great patients. They downplay their symptoms or avoid seeing all the specialists they need to. The insurance company will read every word of your medical records, so you must be clinically honest.
Step 4: Partial vs. Total Disability
As a physician, you might try to work through an injury. You cut back from 50 hours to 20 hours. Your policy terms regarding total vs. partial disability matters.
Total Disability: Cannot perform duties at all. (Pays 100% of benefit.)
Partial/Residual Disability: You are working but losing income due to the disability.
Most policies pay a percentage of the benefit based on your income loss. If you lose 40% of your pre-disability income, they pay 40% of your benefit.
5. The 24-month mental health limit.
Burnout, depression, and anxiety are real. But many policies limit “mental/nervous” claims to 24 months. After that, payments stop - even if you still cannot practice. Understand what your policy covers ahead of time to know how you’re protected.
How to actually get paid.
Buy true own-occupation insurance outside your employer while you are healthy.
Increase your coverage when your pay increases so more of your income is protected.
Understand what your policy does and doesn’t cover.
Document functional limitations when you’re hurt or sick (“could not hold a scalpel for 10 minutes”).
The bottom line.
Disability insurance isn’t about the premium you pay. It’s about the protection you receive when your life falls apart. Your policy can either be a safety net or an expensive piece of paper. The difference comes down to what it actually covers when it matters most.
Not sure if you’re fully protected? Let’s review your coverage today.