Own Occupation Disability definition

[PistolPete]

Is this a standard definition for own occupation? Taken from my individual disability policy:

This rider changes the definition of Total Disability/Totally Disabled in the policy's DEFINITIONS section to read as follows:

TOTAL DISABILITY/TOTALLY DISABLED – Because of Your Injury or Sickness:
1. You are unable to perform the substantial and material duties of Your Regular Occupation; and

2. You are under the regular care of a Physician appropriate for your Injury or Sickness. This Physician's care requirement will be waived when We receive written proof, satisfactory to Us, that further care would be of no benefit to You.

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[cpants]

Is this a standard definition for own occupation? Taken from my individual disability policy:

This rider changes the definition of Total Disability/Totally Disabled in the policy's DEFINITIONS section to read as follows:

TOTAL DISABILITY/TOTALLY DISABLED – Because of Your Injury or Sickness:
1. You are unable to perform the substantial and material duties of Your Regular Occupation; and

2. You are under the regular care of a Physician appropriate for your Injury or Sickness. This Physician's care requirement will be waived when We receive written proof, satisfactory to Us, that further care would be of no benefit to You.

I'd be cautious of this definition. My policy and most of the other policies I looked at had a specific statement regarding physicians. Something like "If you are a physician, your own occupation will be defined as your specific medical specialty or subspecialty." The problem with your definition above is that they could say your occupation is a "physician" not a neurosurgeon, for example. Ie. if you are physically able to perform the duties of a GP, or pyschiatrist, or radiologist...maybe the policy stops paying, even though you would need to do a different residency to do one of those jobs. It's helpful to seek out an agent who works with a lot of physicians. Your GME office can probably direct you to someone local.

 

[PistolPete]

I'd be cautious of this definition. My policy and most of the other policies I looked at had a specific statement regarding physicians. Something like "If you are a physician, your own occupation will be defined as your specific medical specialty or subspecialty." The problem with your definition above is that they could say your occupation is a "physician" not a neurosurgeon, for example. Ie. if you are physically able to perform the duties of a GP, or pyschiatrist, or radiologist...maybe the policy stops paying, even though you would need to do a different residency to do one of those jobs. It's helpful to seek out an agent who works with a lot of physicians. Your GME office can probably direct you to someone local.

Thanks. Earlier in the document they specify my regular occupation as a specific physician rate class, so I think I'm ok, but i'll look into it further.

 

[RangerBob]

I agree with cpants--typically "own occupation" reads like "if you are a physician and have dedicated yourself to a specific specialty, that will be defined as your own occupation." I agree that the wording you quoted above is ambiguous enough that if you could practice as any type of physician, you would not be covered.

The specific physician rate class has to do with your risk (I think being a surgeon/anesthesiologist will cost more). Your rate class is typically different than what the definition of "own occupation" is.

Keep in mind with life insurance, things are pretty clear. With disability insurance, you want to read everything carefully, and you generally get what you pay for.

 

[PistolPete]

Hmmm interesting. This company is supposed to be one of the few that provides true "own occupation" disability insurance for physicians. This is the additional wording:

Regular occupation - Your occupation at the time Disability begins. If You have limited Your practice to a professionally recognized specialty in medicine or law, the specialty will be deemed to be Your Regular Occupation. If You are retired at the time Disability begins, being retired will be deemed to be Your Regular Occupation.

Is that better?

 

[RangerBob]

Hmmm interesting. This company is supposed to be one of the few that provides true "own occupation" disability insurance for physicians. This is the additional wording:

Regular occupation - Your occupation at the time Disability begins. If You have limited Your practice to a professionally recognized specialty in medicine or law, the specialty will be deemed to be Your Regular Occupation. If You are retired at the time Disability begins, being retired will be deemed to be Your Regular Occupation.

Is that better?

That's the key phrasing. If that is written into your policy, then you're good. If you are no longer able to practice your specialty, then you're considered disabled.

Now, one could argue that a surgeon who loses their hand (I think losing both hands/two limbs is often automatically considered disability with most companies) could still do at least surgical consults with use of a scribe/dictation software and maybe an assistant to do some of the exam (which the company may very well pay for--it could be cheaper for them to do that then pay the full disability amount). Of course, you're generally going to want a disability lawyer if you're ever looking at needing to use your disability insurance, and they could help you navigate.

 

[PistolPete]

Yea, that's at the beginning of my policy so I think it's as good as it'll get.

There's definitely a lot of grey, and should it come to it I'd definitely get a Lawyer if they don't wanna pay, but I obviously never want to use the disability insurance. Thanks!

 

[MD Financial Services Scott]

The vast majority of carriers will go to the CPT codes of your billing and if you can't do the specialty (Majority of income generating services) that you were doing then full benefits are paid. As an example if you are an Ortho Surgeon, can't do surgery then even if you are still an Ortho that is consulting full benefits would still be paid.

 

[PistolPete]

How do they calculate residual disability for the residual disability rider? Just based on your practice revenue decline?

 

[MD Financial Services Scott]

Residual is calculated by taking the pre-disability income divided by the post disability income to come up with the % of income lost. Now if you have a true own specialty definition that does not have a "not engaged" clause then residual only comes into play when working in your specialty since the best definition pays 100% regardless of your future income in another occupation.