The Physician's Edition: Ethan & Amber discuss Physician Contracts and Why Group Insurance is Usually Not Enough

In this episode, my guest Ethan Abramowitz and I discuss Own Occupation Disability Income Insurance Contracts and why they are so important for YOU.

It is great to get insight from an attorney's perspective!

In this episode of the Physician's Edition, Ethan discusses how common disability is for everyone, not just physicians. He covers statistics and contract language to break down common misconceptions about disabilities.

This episode covers:

-The definition of Disability under Group contracts as well as Own Occupation Contracts
-The Residual Rider (for partial disabilities and income loss)
-The Most Common Types of Disabilities for his clients
-How to Calculate Benefits to help you determine if you are Underinsured
-How Income protection is a way to provide financial security
-Taxation of Benefits

You can reach Ethan here:
Website: SeltzerLegal.com
Email: EAbramowitz@seltzerlegal.com
Phone: 215-735-4222

Articles for reference: 

https://www.seltzerlegal.com/blog/healthcare-professionals-mental-nervous-long-term-disability-claims-jumped-in-2020/

https://www.seltzerlegal.com/blog/how-erisa-may-affect-your-long-term-disability-benefits/

https://www.seltzerlegal.com/blog/physician-burnout-factors-and-consequences/

Thank you for listening!
Amber

📻 Thank you for tuning in to The Amber Stitt Show!

🔗 Connect with Amber on Social Media:

• AMBER’S INSTAGRAM 
• AMBER’S LINKEDIN 
• AMBER’S FACEBOOK 

📲 Be sure to visit Amber's website:

www.AmberStitt.com

🎬 And remember, let's take action today!!!

====================

💻 Content Creators, Here Are Some Must Have Apps:

🔥 Opus Clips AI Creates Short Videos From Your Full Length Videos: https://www.opus.pro?via=909178

🔥 Find Hosts & Guests for Your Podcast: https://www.joinpodmatch.com/pathways

🔥 For Blogs, Descriptions, or Any Type of AI Generated Text Needed for Your Project: https://www.castmagic.io/?via=amber

Transcript

Copy Transcript Copied

NOTE: This podcast was transcribed by a free AI transcription tool called Otter. Please forgive any typos or errors.

Amber 0:03
Hello and welcome to the Amber Stitt Show and another episode of the Physician's Edition. I am your host Amber Stitt, and today we welcome Ethan Abramowitz, an associate at Seltzer and Associates today, and we are so excited to have him here given his extensive background in the insurance claims process, including pre-suit investigations, advising claims specialists, and counseling insurance companies in house counsel. Ethan has litigated a wide variety of insurance liability and class action matters. Along with conducting insurance fraud investigations, including multiple projects with the special investigation units of the nation's largest insurance companies. So let's just say Ethan represents impaired professionals, which means he lives and breathes insurance contracts specifically long-term disability and employment benefits. That being said, I thought he'd be a perfect guest for my audience because most of you are medical professionals. And you ask us about Own Occupation contracts while you're shopping. And we usually cover it again when we're doing our reviews. So that being said, I thought, Ethan, you're gonna be a great and some clarity to the audience on many of these topics, because you're seeing this every day with your clients. So I really appreciate you being here

Ethan 1:34
It's a pleasure. As you mentioned, I started my career working as an insurance defense attorney representing a lot of the nation's largest insurance companies down in Florida, and with that, working hand in hand with claims departments handling disputes, and investigations, and then transitioned about a part of a decade ago to representing highly skilled professionals, primarily physicians and dentists with individuals with a disability.
And in that capacity, I've worked with my clients really through every phase of the claims process from analyzing and assessing one's coverage prior to submitting a claim to assessing their ability to move forward with a claim to helping clients navigate partial and total disability claims. Obviously, as physicians with partial disability claims, there's always the question of med mouse culpability Is it safe for them to practice both for themselves as opposed to risk for patient safety? Keeping those clients in practice as long as medically appropriate, and then transitioning if necessary to total disability, for dealing with claim denial and terminations and appeals and litigation.

Ethan 2:33
Over the years really, I've seen the good, the bad, and the ugly. These are complex products, like every other type of insurance product, you want to have the best what we refer to as Cadillac policies in the industry. But it the complicated and with every insurance policy, it's what you have and the time of claim that matters. And no one wants to be in a situation where they think they had a Cadillac policy.

Ethan 3:00
And then 10-15 years later, will it be time that they have to go out on disability, they come to realize that what they subjectively believe with their coverage is in fact something that is wholly insufficient, and truly jeopardizes their financial security and the plans that they had. And unfortunately, that's something we see quite a bit. On my end.  As I said, I'm on the back end, someone's coming to me with time to analyze what it takes as far as improving as long as passed. So taking the time to speak with you and your audience to make sure that they initially then understand the importance of these products, the complexity of these products, and really, some tools, maybe what they have and why it might be that I didn't sit down with your team to make sure the coverage that they subjectively believe that lines up with what your team is doing what best suits their financial needs. And I think what will be great is when you're sharing how this actually works will be helpful because we actually have a lot of medical students and first-year residents now purchasing very early so the good news is they're learning about this early but like you're saying, What if they're set up with the wrong structure, and then it 10 years later, it's really hard to fix that especially when there's a medical history and the products would be a lot more expensive because they're older.

Amber
So I think this again will bring some clarity we get a lot of questions at MD disability quotes from my business partner Scott and I that you know, Scott, we often get questions about Own Occupation. In general when they're residents but then they become attendings and we start looking at income changes and a bigger maybe a bigger policy because their income needs or family needs have changed. And then there's group insurance at work and there's that modified own occupation. A lot of times our clients will say, Hey, I'm just going to potentially go with the group plan. I have this at work so I don't need that much more on the Own Occupation side. And so I think with you speaking to us today, I think that'll help them see the differences and how that can really impact their lives. So we could start with you explaining what are people misunderstanding about these contracts often and we could kind of kick it off there.

Ethan 5:24
physician, the resident sits down with someone like us and has the ability to make sure they have the fast available coverage. And we'll talk about it later on. But when you're talking about this common misconception with the clients I work with, through an occupation, that definition which in general terms and we're talking in generalities, if you have due to injury or sickness, the inability for them to have substantial important duties of your occupation.
Then, regardless of your ability to do anything else, you get 100% of your disability benefit.
And it doesn't have a negative effect on your ability to do something else in my world. You know, I've worked with anesthesiologist surgeons, medical specialists who for one reason or another I think what's unique about the medical profession is something as simple seems to be at the base of use the appropriate manual dexterity procedures. That's going to take them out of their medical specialty. That's going to stop the position.

It's not going to affect our ability to do our jobs on a day in day out basis. But that little issue that are referred to the basis has rendered so many of my clients get disabled from working and medical. It hasn't stopped them from pursuing other meaningful career paths. Physicians go through four years of college, medical schooland , residency, additional training down the road, whether it's a fellowship or something else.

So they have this vast knowledge base and skills and and just extensive resources that are highly desirable. In other fields, whether it's transitioning into investments with many medical faculty, or consulting for academics, what have you.

The trauma policy, they get 100% of disability benefit and 100% of the income from the other occupation and some people may look at that and say, well if I can do something else, but what am I really trying to do a cost benefit analysis to get lost in really what's important with your income was designed to grow over time. When you start out as a young physician. You're looking at where's my income going to be at age 6065?

That time period, so someone loses the ability to use their hands or they have spinal issues or something else and their monthly benefit is $10,000 a month.

The question then becomes can they substantiate their anticipated quality of life into the future? And is that income today, supplemented with what other other occupations may transfer into this not only keep them on the same project, Jackie that they were hoping but also they have decided not to maintain their car.

And that's really what we own. Our own occupation definition is designed to protect that specific income stream, that occupation that allows you to make your living to get on the policy grows. So the definition of own occupation is your occupation at the time of disability. So if someone is maybe in a, a

a resident going into the transition from a family medicine or internal medicine prior to surgery, down the road, right? Just because you took a policy out 10 years ago while you're on track, if you become a surgeon down the road, and it's so very specialized, very, very important. Especially for physicians and dentists. Were minor issues or major issues for them.

And the ability that riders start young, some most our clients that we made are younger, but as you subspecialized you don't have to self report these income changes. Or specialties that go more interventional more surgical. That's the benefit to is that price that savings there but also locking in the best health and so starting early.

As their income grows, they can structure policy within themselves.

So someone can buy a policy today that has a monthly benefit exceed $5,000 a month with increase options up to whatever the enrollment limit by the provider is on your end. But as their income goes without the need for additional medical underwriting in the future itfor 's your plan financially base growth. So it doesn't matter if five years down the road after I had a policy issue that I subsequently developed back issues that's not going to prevent from  the company creasing. My coverage is not the benefit it would prevent you from potentially getting a new policy.

Amber 10:56
I actually had a female who had breast cancer and she was in the middle of her anniversary for an effort to increase the increase option and we paused for a minute because she wasn't disabled. She had breast cancer. She was having surgery using PTO and time off that she had at work to to have the surgery. We were able to complete an actual increase option during this whole process that she was recovering because she wasn't disabled. She just had cancer and luckily she got rid of it. So I call it the health field almost helps shield from future issues is something that those options are purely based on.

Ethan 11:39
Which is have you been out of work for more than 90 days and have you bothered?
So if you don't meet the policy definition of disability, there's nothing preventing you from executing that increase.

And we have had clients in the past that maybe have executed limit increase that occurred during a period of disability. And while it didn't trigger while they were on that claim.

That person recovered, went back to work and was no longer disabled with a policy. That coverage was benefits should they ever have to step out. In the future. So yeah, it's positive detail. There's a lot of evolution of the primary beneficiary on your staff to help doctors and protect the financials.

I think one of the questions I think we both see is why are these products important?

Why do I need disability insurance and insurance is always a problematic topic. I know I just had to renew my my auto and homeowner's policy. I have unbundle and as a former insurance defense attorney, I went through it line by line with my broker and make sure that you know I had what I felt was needed and bounce things off each other. But those are policies people that we have to have homeowners we have that auto if you have a family and young children in your early career, and you haven't self insured, life insurance, these are no brainers, what I, what I refer to when we talk about disability is kind of like the topic nobody really wants to discuss a certain topic to say life insurance. ,At some point you're gonna die.

People don't I can't understand how common disability is and just looking at social security.
25% of professionals right now will be calm to stable prior to normal retirement. That's 25 to 30 that which is injured that prevents you from engaging in anything.

Those statistics don't address medical specialty, being an attorney, being a financial adviser, right. So it's looking at that more stringent definition of any gainful occupation. And that's 25%. The other thing your statistics don't ta alk about is residual partial disability.

Amber 14:13
And we've talked about this that's the most confusing topic for my clients is what is residual because they don't understand what the word residual means. It's a component of the partial disability but yeah, that'd be a great place to continue.

They're interchangeable depending on the policy.

Ethan 14:31
But what it is, is if you have an injury or sickness that limits your ability, whether it's time or duty to work at capacity were previously so he can't do one or more of the materials potentially because of your application, or your cause to reduce the number of hours that you work or the number of procedures you're able to perform on a given day and suffer a qualifying or qualifying loss of income. Then a proportionate benefit is triggered on the policy. And tt varies by company by company and details are important. We can spend more time on that a little later. But what's important to know is and I'll touch on in a second is that more often than not when a client comes into my office unless it's an injury, or a sudden event like a heart attack or stroke.

Most of the conditions I see are degenerative in nature, Arthritis, Musculoskeletal, neurological. So they occur over time and then gradually we'll regenerate it and functional capacity will decline over time and as that decline happen. At a certain point your income will decrease because you're no longer able to produce the RV use or CPT codes that are set up for your cost structure. And these benefits are bizarre and you're suffering a loss of income that a policy will then pay a proportionate benefit. So if you have a simple map a 50% loss of income, the policy will then pay a 50% Now what's important on your end when talking with clients is when they're assessing what their coverages that the 50% loss of income.

Let's say you're making simple math $120,000 A year and you've got a 50% loss of income so you're making $10,000 Last night only making $5,000 If you've got a $5,000 month policy and you have a 50% mark that policy is only going to pay you $2,500 a month.

Now you can take the $2,500 from the disability benefit and the $5,000 from your income. That's now a $7,500 a month combined monthly income that you receive there's still a $2,500 deficit.

Amber
And that's something we're strong planning and and working to make sure that they have recommended copper will help bridge that gap and avoid financial issues just this morning, I have a have a question for you. Hopefully it's not going to throw you for the for loop but I had somebody request from me a lower benefit but to add on catastrophic coverage. In my experience, I would prefer to have people have a higher base benefit for that higher multiplying effect based upon everything you're saying. Is that good advice to give them to say I'd prefer maybe to forego a cat writer if it's a cost thing and go bigger in the base. What do you think about that?
We've both been and I'll go through the leading cause of disability but think about it this way the catastrophic is an add on rider.

Ethan
So you have a high base and supplement that with the catastrophic loss. If you do have a catastrophic, catastrophic medical condition you're still getting the base plus the catastrophic ride on versus if you don't have a catastrophic medical condition.

You've already set your your monthly benefit at a reduced rate. And that's only rely on the catastrophic loss thereby missing out on the leading causes of disability.

Right. Well, I think when we talk about it's a good segue is that the base benefit should be 60 to 70% of your gross monthly earnings.

And that's to cover tax liability and that's to make sure that you're able to maintain your current body without having to dip into your savings and start jeopardizing financial security in the future.

Oftentimes people don't understand the financial consequences of being underinsured and that's the situation I'm hearing that kind of client who we're talking with, made me missing which is Social Security statistics show that 38% of disabled professionals will struggle to pay their normal living expenses within three months of losing the regular income stream.

Three months yeah, that's why we see the elimination period said three months but I think what's more troubling is that 65% of this batch will be unable to pay their normal living expenses the year.

So the question then becomes to the person you were talking to earlier, which is can you pay your normal living expenses rely on the base disability benefit versus having to rely on the catastrophic disability benefit?

And often what happens when I see clients on my end that haven't done a deep dive into the analysis of that 67% of colleges?

....coming in the other day, making more than $500,000 a year.  We had a $10,000 a month individual disability.

We also had provided long term disability benefit that was timed out and as well. That benefit the Group Policy was subject to a 24 month limitation for overnight coverage. It was subject to tax liability and deductible sources of income and the dark was meant to return I can't afford to be to say, I can't maintain I'm gonna sell my house. I'm going to have to dive into my savings.

And those are conversations that we never want to have. But also and that's the you're talking about the to a 24 month modifying an occupation people see own occupation, they think they're safe.

Is that what you're talking about? And then after 24 months, I think one of the one of the common misconceptions with group Long Term Disability,  the employer provided plan.

When we talk about own occupation coverage, it's an umbrella.

And under that umbrella, there's True Own Occupation policies, which typically are only provided in the individual disability line, guaranteed standard issue, product line, and association.

Now each of those other two gadgets, standard issue and association policy, other issues within them that in my personal opinion, potentially weaken the coverage compared to a true own occupation, or disability policy.

But more often than not the general definition in a group Long Term Disability planning software, long lines due to injury or sickness, run your occupation and have a 20% loss of earnings. And then what we'll often see is that after 24 months of old occupation cover after 24 months of disability. The definition is that due to injury signature unable to accept any game plan based on education, training, experience, and policies vary there's different qualifications for any gainful occupation. But if you've got if the policy doesn't have that they've been rolled back or soldiers to definition, which is of any gainful occupation, it's normally like it varies year to year. But if you can generate roughly 1100 to $1,300 a month you no longer need the policy definition of disability and your claim terminate.

So the problem I'll say is your mind is that doctors are bent on a position of well I shouldn't be practicing. My treatment team has advised me that I'm a risk to my safety and well being as well as patient safety.

And we've seen doctors put their financial security ahead of their health and well being in patient safety. And it's an awful situation. I had one client, an old client that had an oral surgeon who was told by his neurologist yet to and from a non Parkinson to start practicing six months before he walked in my door.

And wow, so he was practicing still prior to coming from leaves advise to stop and he wanted to pursue a partial disability and I'm going through his medical records I'm speaking to his neurologist. It took another four months for us to finally sit him down and say listen, this is what your medical condition.

We understand that you think you can safely practice your doctors telling them that you can't you're modifying kind of practice. And if something goes wrong, you now suffer potential for modes of liability. At a height work directly you acknowledge that you're modifying and changing costs that the sensitive nature of the work is not who is doing and he eventually said that I think that's one of the hardest things for any professional, but specifically acknowledging that maybe it's no longer safe for them to work.

And that's a conversation we had to do later but nobody wants to admit they have a medical condition that nobody wants to acknowledge that they may become disabled down the road and historically, almost my father suffered a catastrophic stroke 73 I've worked with and represented former friends and colleagues I've represented just from past life, I can go through a list of at least five people that I have close personal professional relationships with that have had to go out on disability. That's just from my profession that I know, let alone and we're talking about carnies.

Right, again, it's a tough concept for people that process but the importance of these products because of the prevalence and the likelihood, again, a 25% chance.

That may be something that people look at and say well, that's a low probability. But when you sit in a room for people and you're looking around and saying I want to probably get great changes.

I think a lot of physicians that we meet might be looking at generating some side income today. So let's just say rental income would not be gainful employment. Would you agree with that? When we look at your, your occupation, the definition is that we occupation occupations even if someone is working in a medical spa, or a nightclub and 100% of their income and time has arrived.

It's pretty clear cut lead or occupation. If someone has a passive investment in real estate project, and they're not attending to the day to day operation, but they have a management team, it's worth it with family business and the occupation is going to be the medical component, where I see things may probably be complex when we talk about occupation definition because if I have a physician or somebody medicine, time entrepreneurs, when they really haven't, are focused in one occupation, they're not doing and we do see that someone who is not only generating energy, from the performance of personal services from practicing medicine, being the physician is going to be the definition that carries in the politics.

Amber 27:14
I think another interesting part of our world just with technology and different opportunities to generate income, if there's a physician that's disabled, I really feel that there's probably something as long as their mind is working that they could do in the future. The reason I bring this up is sometimes I have Radiologist, Diagnostic Radiologist and Psychiatrists that say: "Hey, I can work from anywhere. Do I really need this Own Occupation rider? We looked at the cost differences. It could be a little you know, kind of substantial savings, but I think having that protective layer just in case you are sitting down in a wheelchair, speaking to an a large audience, collecting a consulting fee, that's income. There's opportunities to work if our brain works outside of medicine. I think that writer is so important because we can't tell what is going to be available to us in the future for from an income producing perspective. So I'm seeing you nodding your head and you're agreeing that gosh, it could be any 10 I work with a number of radiologists and a handful of psychiatrists.

Ethan 28:23
And the question then becomes, well, I can do my job from anywhere like you're saying no I just have to sit and luckily, I think what is often lost is with the clients I've worked with, specifically radiologists diagnostically offices, they will be suffering from a physical issue that affects their ability to sit for extended periods of time where they may have visual impairment that comes in will sit and look at a screen for extended periods of time. And it may not take them out concretely, but it may cause them to have to take more frequent breaks and stuff away. And then we see the total number of reports are producing and that would put them in a partial disability scenario. We have other clients that have had to stop because whether it's something like Parkinson's disease or normal muscle degeneration, where they can't sit on then it will work. I can't sit and maintain or sustain employment as a radiologist. But you can do something else, like Consulting at your leisure and we do have clients that do that where it's you're not winning when your reality you're sending images that you need to get back to the treatment providers pretty quickly.

But there are other you know, consulting and expert type work out there were a take a look at this one. You can give us a report when you're able and it's something that can spread out over a few days. So they're still able to contribute you're still able to generate an income but they're not able to do radiology because they just can't do it stay up with the occupational meds to actually be gainfully employed.

And that's so interesting that sitting component being such a factor that could be any one of us. I think before we wrap up the occupation definitions, I would the well gosh, let me just ask you segwayed into a good part, which is one of the most common causes of disability.

And what we see and I think what what the available data shows is that 30% of disability claims are based on musculoskeletal disorders.

As well as we're competing in neurological disorders. Only 10% of disability claims are the result of injury or other causes of cancer. Mental Health and Addiction related disorders is actually the fastest growing throughout the pandemic.

Unknown 31:15
Not only the long haul coding issues, but people struggling with mental health and substance use even people that were in recovery, relapsing.

It's also I will see a lot of especially in the group policies the long term disability policies will take money from our conversation, but they'll also have heart disease and subjective claims like chronic fatigue syndrome and fibromyalgia and chronic pain. So I think that's important.

Because what we learn when we look at what the common cause with disability are, is that most of them are degenerative in nature, as we were talking about earlier, okay, progressive decline over time, which highlights the importance of a partial residual disability rider.

I think it also said, segues into a lot of people not understanding how these medical conditions trigger the elimination period, and a policy and the elimination. Could you can go back in time from the Onset date. I think you told me a story, working with one of your clients that it went back quite a bit every time I work with a client. The first thing I do is after my intake, we gather the medical data, the production, data, the financial and we look to see is there a date back in time where the medical shows severity such that we see functional impairment that's reflected in a decline or reduction in work capacity, that then shows a loss of money.

And I have multiple clients that I've worked with over the years where we've been able to go back four or five plus years in time recovery of hundreds of 1000s of dollars. I have one client that we were able to recover over $500,000 in part of disability benefits. Because when that client came into our office, she was only focused on a total disability claim and did not understand how her partial residual disability work.

Now it's not on every claim. Do that obviously. And it's very fact specific with regard to dealing with in tracks with opponents like late notice. And do we have all the medical that we need do we have or financial prosecutors that we can line up and actually show that someone was suffering that core issue, and it was severe enough to affect application and they did have the economic loss. But even if it's not five, even if it's pushing it back a month or two or three or four, the elimination period is the number of days you have to meet the policy definition before the benefit itself. Before you become eligible to be paid.

If it's a 90 day elimination period, and someone walks in thinking that they were disabled on June 1, and you look and say well, you started cutting back in in January. There's six months here.

Well, yeah, I did come back and I was talking to my doctor but you know I wasn't a woman you want to be income and you see that reduction.

You're able to push it back I think not not to get too far down the road but the other important is certain residual disability riders require lots of earnings.

And again, it's it's not a one size fits all approach certain. Certain don't. Some have to make sense with the other coverage is better, but with certain products don't requirements for the elimination of but on every claim more often than not people aren't aware of when maybe they started coming back. And again, it's not every case but once you are able to push a claim back in time, that's more money in the claimants pocket because he's exhausted the elimination period when it's justified.

Amber 35:17
Yeah, sounds like you're able to help people really get through this process and not just really see the whole picture so that the claims process can go as smooth as possible.

Ethan 35:28
When it comes to Well, I think I remember what I was about to say before. I don't work on the group contract side I work with individuals so I don't think people understand that if you have income and think there's income flowing through your tax return, that's part of that claims process every year. And it might be with the private plan too. But that's happening to calculate an offset your benefit if you have if you're solely relying on contracts, there's usually some piece of that contract that's going to offset or remove your benefits away from a group policy.

I've yet to see why. That is a true own occupation policy. I can't work as an anesthesiologist. When I'm sick they kept me on working with medical director under Group Policy, there's typically a disabled while working permission or just general under the source of income that will say income generated from purchasing services. And what that means is that if I'm working, not my occupation, their potential depends on how the policies work. There could be $1 per dollar offset. So if I'm making a $10,000 mark that on under the LTD plan and I'm making $5,000 a month regardless of what I was making pre disability and what the percentage loss is, they'll automatically cut it dollar for dollar there are other policies that have more formulaic approaches to how it's handled. Some will say that it's they will look at your pre disability earnings and that number and what that was. They will look at your current monthly earnings and the disability benefit and for the first 12 months or 24 months that your benefit won't be refunded as long as your current income and your gross benefit from the LTD don't exceed 100% of your pre disability monthly earnings. Right so then that changes after 12 months or 24 months. Or it's done either $1 for dollar or percentage loss or what we've seen those products will have 50% of your monthly earnings and the new occupation will be deducted from your benefit. So if you have a $10,000 month benefit and you're making $5,000 a month, they'll deduct that benefit by 2500.


So it varies and a lot of people see the spec page that they get for the summary plan this whole plan and think oh this is great complement those definitions and minutia and detail isn't spelled out clearly. And you really have to do a good dive right under standard efficiencies in the group products.

Do the group contracts typically assign an attorney to that person? Or are people looking for their own representation at this time, no copy of the signs and attorney to help anyone right now we're hoping that the claim claims process is tricky. Not not just ignorant pat myself on the back or minimize what people are able to do on their own but when you're submitting a claim the first thing you'd have to do is notify the company.

So notice and then once you do that the company sends a packet which has the claimant statement, employer statement, attending physician statements but they also want a laundry list of information. So the ability to gather all that information, put it together in a cold concise way and ship it off to the company by test but the burden of proof is suicide.

So what we see happen with clients a consultant with general questions and people that don't end up aren't the company the big brand insurance company isn't paying me and putting me through the wringer here. I'm like well, what what's the problem? Well, they don't my records and I don't think they are entitled to. So I've seen a lot of potential clients and people that it's just a quick phone call. They don't understand what the company need to claim. One of the things I do online is when someone retains me, I gather all the information that I know a couple of weeks of profit.

And if information is missing, whether it's financial or production, we figure out how to supplement that one way or another. But it's going back to the employer and saying okay, we don't have production records. Can you provide an employer statement outlining the duties time schedule, or the calendar for whatever's needed to need the proof of loss or climate that we chose bears the burden of proof to substantiate the claim?

What typically happens in a claim is the physician will get the initial claim packet forms and then they get frustrated when the company starts coming back and I'm like, gentlemen Crusher, you're gonna have to substantiate the conclusion. They have to substantiate the medical you have to substantiate lots of primary partial claim, verify income loss.

Because people could go on part parcel and then full or back and forth depending upon recovery and kind of treatments are there so all of that is they're going to take that pretty seriously.

Now work with with claimants and I'm on the other side of that, you know, dealing with insurance companies. Yeah, but a lot of insurance companies out there a lot of bad insurance companies out there I don't generalize, but I've seen claims that I never thought would get paid, get paid 17 claims that I thought should be approved by the way when the client gets through the foot put through the wringer. And it's a fight back case by case basis.

But the one thing that rings true with any case I deal with is the proof of loss matters. The paper, the policy, the four corners and the coverage is what matters and what problems and if you've got a very good policy and you can substantiate a claim, at a certain point in time the company will have to accept liability. When you've got a questionable claim, and you're not getting appropriate care that or other issues, then it's going to be a lot harder and they're gonna do what they can to raise questions and they're just they're gonna check but the key is doing your due diligence at the beginning and making your mind off. Yeah, trying to get everything at a time. So hey, company, you have everything open. You got a couple questions after they go through that with you not.

Amber 42:29
I used to do contract negotiations with physicians part of just the indirect compensation pieces benefits and the people that are high production, not just a base salary with w two income.

And when we were negotiating, what kind of production models and when the the bonuses would be reconciled. I always I always told people not even talking about disability at that time, but keep track of all of this though, spreadsheets, any of that data because I'm guessing if you were to say, to wrap up this episode, if there were some takeaways, if you could give people you've already given a ton of gems, but what are some takeaways as people are going into practice outside of training, you know, outside of that w two every you know, paychecks are pretty consistent. What would be a good practice for them? Like you know, I always say put things online, cloud based, almost like an office setup for yourself and keep track of things so that to grab those documents, they're just available to any thoughts like that that would be helpful to share candidate

Ethan,
Yeah, I've wrapped one thing because if I get a I have my disability policies that I got most years ago. Don't file in my in my office at home. My wife knows where that is. She knows where my life insurance and all the other policies are. But I pay someone to do I know my policy. I think for physicians that have a policy and they haven't sat down with you and it's gotten your tea in the background to take the part that you don't have it, get a duplicate copy of it and go look at your group long term plan.

The other thing I noticed that employer provided plans they can change year by year. The individual branches you have this year, you can increase the benefit if you have a future increase often.

But the coverage doesn't modify. The only thing that happens is if you don't pay the premiums that will lie to your province or set in stone doesn't prevent you from going out and getting other policies and supplementing it. If you feel like you do have a policy but understand your product standing up on your employer.

I think one of the things that pose a lot of my clients is and we're talking about earlier with the partial disability claims income spot.

We got to have an enviable segment but I think I'm always amazed that people don't keep track of their annual earnings and the percentage loss or gain each year. So, typically would have a part of a disability rider it's affecting quite some off earnings.

Ethan 45:17
That's significant law. But what many occurred is that the formula it's it's in the policy varies by company but it's typically something that the following is greater than 12 months immunity prior best two consecutive years out courier past two years that by so it's a formula and understanding that formula, but more more importantly, the physician is working and they're cutting back to a medical issue. And they're seeing that their incomes drop.
Or no that was maybe a bonus combo type, structure the structure.

Unknown 46:11
I feel like we have to tell some of these stories to make it real because a lot of times we're transferring risk like you said with auto and home, kind of have to do that with with the price points of these policies that can be a little tricky to think about when is the time to do this. But we always say the earlier the better. Not so much about the cost. I mean, it's about the cost but it's really about your health and getting a really nice offer and then not having to worry about that. So I'm hoping that listeners are going to be a little bit more proactive after listening to you and our podcast today and really trying to put some steps to be more proactive than reactive. I always say take action today you know if you can it's not a good thing to be doing everything on the other side. So before we wrap up, where can our listeners find you if they need your help? www.Seltzerlega.com.

Feel free to call me at the office as well as by concerns 215-735-422 Or they can also email me at EAbramowitz@seltzerlegal.com And, as always, take time and answer quick questions.
And yeah I know that you've been helpful to we've you've helped people have a few minutes on the phone to kind of figure out what the next steps are. We always appreciate someone contemplating coverage or pursuing a claim. Five minutes of my time more will not be able to provide someone with a roadmap of where to go and what they need to do. Whether or not they actually need my services are not always perfect.

Amber 47:53
I'll link some of your information in the podcast notes below to from this episode so that that'll be easy for people to get to and I think I'll link a couple you have a couple of white papers as well. So that can be helpful. So I hope that everyone's enjoyed this episode. And have a great day and goodbye for now.

Thank you for joining us on today's episode of the amber Stitt show physicians edition. For more information about this podcast, books, articles, and more, please visit me at Amber stitt.com. For more information about physician insurance contracts, please listen to the entire physician edition podcast series or visit us at MD disability quotes.com.

Transcribed by https://otter.ai

Thank you again for joining me, Amber Stitt, in this episode of The Physician's Edition. I’ll see you next time, podcasters!