I have a question for those of you who have disability insurance. I'm currently shopping around and was curious to know which insurer most here use. I was told that Guardian has "occupation specific" for pain management (meaning if you can't perform duties specific to pain management, the policy would pay out). Can anyone confirm that? The local broker couldn't find pain management. Any thoughts/suggestions?
Disability Insurance for Pain Medicine
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There are three that fit our needs (according to my CFP). Berk Gaurdian is one, American General is another, and I cannot find the page he gave me outlining the policies of all 3.
Talk to the right people. Here is an email from an estate attorney when asked the difference between AMA and Guardian disability policy:
There are many issues that would require me to look at the actual policy in order to properly respond, but basically the easier ones are as follows: premiums are not fixed (I am sure they are age bracketed), and they are not guaranteed to age 65. Also, the AMA is not an insurance company. They create programs with carriers. The carriers can drop out, change the pricing, change the terms of the contract. There are no protections. Guardian can change nothing to an insured's age 65. That, in and of itself, is reason enough. He might feel comfortable with this type of plan, but he has no certainty.
Guardian protects an insured in his own occupation to age 65. AMA does not. It protects one only for five years in his occupation. Then it is an any occupation program. This puts the carrier in a strong position of telling an insured after five years that he is capable of doing something consistent with his education, training and experience. He could see his benefits stopped even if he doesn't have a job and even if he has a job in another occupation, but has suffered a significant income loss. He would just no longer meet the definition of "total disability".
There is no COLA benefit in the AMA coverage.
There is a significant problem with the residual or partial benefits. Below is the terminology from the AMA summary.
The Residual Benefits for Part-Time Work
This plan allows you to make a gradual transition back to full-time employment following a covered total disability. (Emphasis added.)
This creates two major areas of areas of concern as the insured must first be totally disabled to receive any residual benefits. There are two fairly typical situations where a claim can occur. First, if he suffers from a debilitating illness (ALS, MS, Parkinson's), he will gradually lose his ability to work. His income would decrease in a similar fashion yet he will not have ever been totally disabled to trigger the residual claim. No claim would be paid until he was first totally disabled for the waiting period. I have a client with MS and if she had the AMA coverage, it would have been 2-3 years before she would have met the definition of total disability. With Guardian, the benefits would have started much sooner.
Second, if the insured has some accident or sickness for which he is totally disabled for less than the waiting period and then he returns on a part-time basis, he would never had a covered disability. He would see a partial loss and have no benefit paid to him as he never had a covered total disability. I think this is a giant hole in the AMA plan.
Two other issues that are important. First, if an insured is out for a period of time to the point that he does not have a medical practice to which he can return even though he is fully recovered, the AMA would pay no benefit, but Guardian would pay a benefit based on lost income as long as one can tell that the loss is a result of the disability. Second, if he is out and returns and goes out again, the AMA coverage likely says if he is back more than six months, the insured must start a new waiting period. Guardian allows for twelve months back before starting a new waiting period should a new claim occur.
The AMA has policy offsets. I know there is a cap in the amount of coverage they will pay a benefit on so it is possible that AMA coverage will pay less if you have group or individual coverage. I also think there may be workers comp and Social Security offsets in the AMA plan, but I would have to see. Guardian has no such restrictions.
A final issue (there may be more, but I have to see the actual policy) is what happens at claim time. For AMA, the insured has to find help to walk through a claim and avoid the pitfalls and challenges. Where does the insured go for help? No where. For the Guardian coverage, both Stephen Kruse and I are there to get it done. It is part of the cost of your premium dollars that we are there for an insured when one is at his most vulnerable.
I would suggest one gets what one pays for and, Steve (Dr., not Stephen), I think your friend might benefit from talking to Stephen and me. Call or write a note if you wish to discuss this further.
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I had an agent from a site at http://www.disability-insurance-update.com call me. She took me through the options and provided quotes from 6 different companies. The key thing was to have an "own occupation" definition of disability which defines me as disabled unless I can do my actual specialty, not just any job. I liked the fact I could compare and didn't have the feeling she was pushing any one company. I bought short term and long term policies that cover me up to 70% of my income if I'm out.
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...and my policies are from Assurant.
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Keep in mind to be determined to be disabled, you must have a doctor fill our ALL the required paperwork, in a TIMELY manner, on a REGULAR basis.
How many of you here are willing to fill out the exact same paperwork, for a patient, with the exact same wording, month after month, ad infinitum, documenting everything that your patient is able to do, the entire work-up to date, the plan of care, response to this plan of care, side effects of medications tried, etc, and documenting the specific OBJECTIVE measurements that define why he is now disabled and continues to be, along with the projected RETURN TO WORK date, both for limited duty and full duty, and if none can be supplied, then the OBJECTIVE signs of why?
The system is set up to take your money for an assurance of protection, and when you need to collect, they will set up as many stumbling blocks as they can, many out of your sphere of control, and then send you a letter stating "Aww, gee, we wanted to send you your check this month, but your doctor did not get us the form on time. We are closing this case. You can always file an appeal (which will take months)."
How many of you here are willing to fill out the exact same paperwork, for a patient, with the exact same wording, month after month, ad infinitum, documenting everything that your patient is able to do, the entire work-up to date, the plan of care, response to this plan of care, side effects of medications tried, etc, and documenting the specific OBJECTIVE measurements that define why he is now disabled and continues to be, along with the projected RETURN TO WORK date, both for limited duty and full duty, and if none can be supplied, then the OBJECTIVE signs of why?
The system is set up to take your money for an assurance of protection, and when you need to collect, they will set up as many stumbling blocks as they can, many out of your sphere of control, and then send you a letter stating "Aww, gee, we wanted to send you your check this month, but your doctor did not get us the form on time. We are closing this case. You can always file an appeal (which will take months)."
You maybe be entirely right PMR4, but I still think that I will take my chances with the disability insurance.
I've heard that most insurance companies will define own occupation as (in our cases) Physical Medicine and Rehabilitation or Anesthesiology. I've been told that Gaurdian and a few others will go beyond that and say your occupation is pain management. Therefore if I get severe Parkinson's Disease and can't hold an epidural needle with any stability, the insurance company can say..."well, you can still do some general physiatry". As we all know, a general physiatrists average income is significantly lower than an interventionalist. Therefore, your policy will not pay out. This is why own occupation needs to be specific to pain mangement.
My question...Does anyone have one of these policies specific to pain management?
I've heard that most insurance companies will define own occupation as (in our cases) Physical Medicine and Rehabilitation or Anesthesiology. I've been told that Gaurdian and a few others will go beyond that and say your occupation is pain management. Therefore if I get severe Parkinson's Disease and can't hold an epidural needle with any stability, the insurance company can say..."well, you can still do some general physiatry". As we all know, a general physiatrists average income is significantly lower than an interventionalist. Therefore, your policy will not pay out. This is why own occupation needs to be specific to pain mangement.
My question...Does anyone have one of these policies specific to pain management?
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All I can say is that my policy explicitly states that my occupation is as a podiatrist. Never had the occasion to ask about pain management. An independent broker can check multiple carriers for you at once.
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That is why you have the own-occupation clause including the hand-motor coordination for performing procedures. My Guardian policy includes this due to the EMG/injection component. So IF i have something like MS, where I can't inject but still can see patients, I will technically be 'disabled' but can still work and have income.
Mine is PM&R btw.
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Appropriately written policies accurately describe the day to day activities of the current own occupation and are not a Title: Captain of the Enterprise.
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Self-funded account - If you are self-employed, your state may allow you to put pre-tax money aside in an account, possibly interest-bearing for such an occasion. It takes discipline and a bet that you won't need it for several years. $1000/mo @ 5% interest x 5 years = $68K cushion, 10 years = $150K.
Otherwise take second-best and go for Guardian. Just realize and resistance the hoops you'll encounter when you try to collect.
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At that point I take a 1-way ticket to the Caymans and beyond, taking as much of my net worth with me as I can.
http://www.amazon.com/Hide-Assets-D...d_bbs_7?ie=UTF8&s=books&qid=1222441189&sr=8-7
