When I was working full-time in the Urgent Care at Kaiser Permanente in Southern California I would regularly see patients who were on disability. The most common reasons for disability were back pain, neuropathy, diabetes, obesity, and knee pains.
The topic of disability and unemployment is complicated and skewed due to political influences. Unemployment benefits are paid out by the state while disability comes from federal money. As a state it makes sense to push your unemployed residents to get on disability which stops the state’s economic bleeding and brings in fresh federal dollars into the state.
This post won’t cover the political topic of disability but I will be talking about physicians and disability. Far fewer physicians take advantage of disability even though many more physicians should. Presenteeism is an epidemic among physicians and so is silent suffering.
Among professionals physicians have the highest suicide rates and the highest burnout rates from the studies I have reviewed. Physicians don’t have unions and there is no coalition designed to protect physicians’ rights.
Physicians are also the financial pillars of not just their own immediate family but often their extended family and even their local community. Physicians help out their churches, their neighbors, their in-laws, and donate to various local organizations. If nothing else, they patronage the shit out of coffee shops.
Disability, for the purpose of this post, is a legal designation affecting the workforce where an insurance group, the government, or higher courts deem a person unable to earn a living wage through employment.
Disability is a contested topic because like any other benefit it can be abused. There is a false public assumption that individuals prefer to be unemployed and be paid by someone else to do nothing. Multiple studies have demonstrated this to be false. Human beings thrive on productivity when their mental and physical health allows it.
We have in mind a fat person sitting on their porch drinking beer with an unkempt yard living off gov’t cheese. What a fucking slob. What a mooch.
But that’s not the whole truth. With a broad stroke we dismiss that individual’s substance addiction, their major depression, their bipolar disorder, their chronic pain disorder, their insomnia due to OSA, their neuropathy from their diabetes, or their inability to hold down a job in an ever-more structured workplace.
The problem is achieving and maintenance of health which might seem so simple to some but is a far reach for others.
This income is further broken down because the disability income may be for a partial disability or full disability. It might come from Social Security’s “Supplemental Income” which is currently a maximum of $800/month or an actual disability amount based on your income while you were employed, also from the SSA.
On the private side it’s a similar issue. The disability income might be temporary, partial, or full. I won’t be covering SSA disability in this post but everything I mention should carry over quite well.
Some 60 million individuals in the US are considered to be disabled. Not all of these are depending on disability income from the government or an insurance company. Many are able to still work and provide a living for themselves despite their disability.
When a person petitions for disability 60% of these claims are denied reflexively by both the SSA and private insurance companies.
After an initial denial the appeals process often has an even lower chance – somewhere in the 80% denial rate.
I mention disability denials because over the years there have been many successful lawsuits of insurance companies who have refused to pay out for legitimate disability claims. This has reached epidemic proportions to the point of states now regulating each insurance company as to how they handle disability claims.
The main point here is that once you need your disability income you better be ready to fight for it because it won’t come easy no matter how diligently you researched your disability policy and how attentively you made your monthly premium payments.
Physicians & Disability
A physician will keep working full-time even if they have severe and chronic back pains. They will work even if they have migraines, IBD, autoimmune arthritis, MS, diabetes, substance abuse disorders, major depression, insomnia, or PTSD.
Sure, physicians may call in sick here and there. A few might make use of FMLA in order to get their absences excused and prevent their medical group from retaliating against them.
As physicians we are retaliated against because our medical groups will hold our FMLA usage and our sick calls against us. You would know this to be the case when you come up for your annual review or considered for partnerships or when you place for a transfer to another medical office.
Physicians are experts at suffering silently – female physicians more so than male physicians. The public, the government, and the insurance companies all are banking on our willingness to suffer without speaking out.
Physicians rank among the highest professional group when it comes to not reporting their impaired colleagues. There are many reasons but we believe that suffering is normal and if it’s good enough for us then it’s good enough for our colleagues.
As a group we have a higher burnout rate and we have a lower lifespan. This might mean that we take worse care of ourselves.
That depression that we left untreated or for which we prescribed ourselves some Lexapro will decrease our quality of life and affect the way we eat, how often we exercise, and how we interact with our family.
We go to work with physical injuries, with pneumonias, with influenza, with gastroenteritis, with PMDD, and with IBD bleeds.
Burnout leads to emotional problems which leads to physical problems which decreases productivity and affects our output. This is obvious to economists and lawyers but not to physicians.
When do you think physicians are most likely to be sued or to make clinical errors? It’s often when they are experiencing personal life problems or work-related problems. We don’t get a pass if we make mistakes during such times. You are held to the same standard as a physician who has no stressors, no physical, or emotional problems at the time of treating that patient.
I have physician colleagues who practice full-time with severe neuropathy, substance abuse, amputated digits, major depression, chronic pain, migraines, and severe menstrual pains.
When the work is already too hard to do with perfect health then it’s fair to assume that our performance drops when we are suffering with chronic and disabling conditions.
When we are suffering then we might make more errors, we may not offer as much preventative care, we may not be as thorough, and we might take shortcuts to get out of the exam-room and into a more comfortable setting.
Applying for Disability
Nobody wants to think about one day dying or having to apply for disability but the odds are stacked against us on a long enough time horizon.
Physicians often make terrible decisions when it comes to applying for disability which is why many are denied. Guess what, the government and the disability insurance companies know this. They bank on your making such mistakes in hopes of denying you.
This post is to help you fight back and beat them at their own game.
Your Disability Policy
You either have a workplace disability policy (sometimes called a group policy) or a private policy (sometimes called a supplemental policy) which you pay for yourself. As a last resort you can also apply for the government’s disability through the SSA.
Your group policy won’t be a great policy and though it will likely cover you if you become wheelchair-bound or blind, it will be hard for you to get a disability claim approved for more benign but unfortunately much more common health problems.
The ideal situation is that you have an own-occupation rider in your policy which means that as an Urgent Care provider who sees patients in the Urgent Care, I would be considered fully disabled if I’m no longer able to perform that specific work even if I can still see patients online doing telemedicine.
The 1990’s Skew
Physicians of my generation have been raised in a professional environment where it’s assumed that it’s impossible to get approved for disability. After the research I’ve done to write this post, I can see why.
This stems from the events in the disability marketplace in the 1990’s. Insurance companies started heavily marketing to physicians because they knew that doctors wouldn’t file for disabilities and they were willing to deal with any bullshit laid on them.
Unfortunately, these insurance companies sold inflated policies to physicians with poor underwriting. Once managed care came on the scene and physicians were no longer compensated for their hard work, they no longer were willing to justify killing themselves for the sake of their patients.
In the 1990’s physicians filed for disabilities and had little problem getting approved because of that weak underwriting I mentioned. The insurance companies took a hit because of their greed.
Moving forward the insurance companies changed their wording and adopted widespread claim denials and thus the culture changed. Few physicians believed that it’s possible for them to actually get approved for their disability even if they were disabled.
Interestingly, around the 1990’s a lot of philosophic papers came out pointing out that physicians had a moral obligation to their patients which should supersede their own level of comfort. I wonder who commissioned these writers?
What Physicians Do Wrong
First, physicians won’t file for disability when they should be filing for it – they will suffer needlessly and create bigger health problems for themselves.
They also don’t grasp the concept of partial disability where they might get 20% or 50% of their max benefit paid out monthly while still retaining the ability to work on the side to supplement the rest of their income.
Physicians also don’t anticipate the need for disability even though as I’ve pointed out they are at a far higher risk for needing disability income.
On the other end of the spectrum they believe that because they have a disability policy they will be covered should they ever need to file for disability. But it’s the physician’s tenacity and moral dedication to their career which often fucks them over.
The worst things that physicians do, which nearly guarantees a denial of their disability claim, is that they compensate for their disability. Lemme ‘splain.
Compensating For The Disability
Here is a bit of blunt truth for my physician audience. If you’re not taking care of your body or your mind then you’re going to suffer some consequence of it down the road.
Whether it’s cancer, a heart attack, a stroke, or major joint degeneration, you would have to deal with some sort of consequence down the road. Maybe medications and surgery could alleviate some of your symptoms but then you’d have to deal with the side effects of the intervention.
If you treat patients with hyperlipidemia then you know about the many side effects of statins which can cause type 2 diabetes, neuropathy, and the ‘statin fog’.
What physicians do is at first bulldoze through their health condition until they are burnt out. Then they start missing work because their body and minds give up. They then compensate for these problems by changing their job or their work responsibilities.
Unfortunately, many also go through personal problems around this time and might pick up a couple of extra bad habits like too much drinking or starting their morning off with a warm morphine enema.
Since physicians have a far higher divorce rate than the average population, this is probably a good time as any for their relationship to fall apart and for financial problems to set in. This might mean that they will stop paying for their private disability policy or they might take a job where not even a shitty group disability policy is offered.
When the physician stops working in the OR because their back hurts so bad and decides to review charts in their medical group or do more office-based visits then they have suddenly changed the nature of their work. That “own-occupation” clause could get voided because leading up to their disability claim they weren’t even a surgeon or an Urgent Care doctor – they were an outpatient clinician or an administrator.
How to Approach Disability
If you anticipate that one day you’ll need to file for disability whether due to your current health condition or family history or how hard you’re pushing yourself, it’s important to plan ahead.
First I would suggest getting over the stigma of disability. If you feel that claiming disability makes you look weak, dependent, or incompetent then I would either work extra hard to become financially independent or to question where your stereotype comes from.
1. Legal Help
Get legal help now. Not when you’re ready to claim disability but now when it’s not yet imminent.
It doesn’t have to cost a lot. You can pay an hourly rate of $250 to a very competent disability attorney to have them first review your current group policy and your supplemental disability policy, if you have one. If you don’t then they might recommend one and tell you which ones are the best based on the state you live in.
Are you depressed? Are you in so much pain that you cannot fathom another 4 hours on your feet cutting into a knee? Are you tired of making excuses to run out of the exam room to take a shit with your IBS?
Stop compensating and start calling in sick. More importantly, start seeing a physician. It’s important to have a documented history of being seen for a particular condition over the years.
You don’t need to mention to your doctor that you’re trying to file for disability but at least get seen. Have the proper workup done. Have things documented. Take steps to remedy the problem. Keep a pain log and have your doctor scan that into your chart.
See a psychiatrist, a therapist, or an addiction counselor if you have to.
3. Changing Your Job Title
This goes along the same lines of compensating for your potential disability. If you’re going to work every day with severe panic attacks and cannot stand being in the exam room for more than 60 seconds then don’t go switching to doing telemedicine unless that’s what you want to do.
Don’t cut your OR time and do chart reviews or rounding just because your neck pain is preventing you from doing what you’ve been trained to do.
By making these concessions you are making it much easier for the insurer to argue that your work isn’t what you were underwritten for. Denied.
4. Returning to Work Too Early
It’s normal to attempt a trial at returning to work but that needs to be clearly documented with proper work modifications. It’s far beyond the scope of this post for me to get into. Any competent lawyer can tell you exactly how that should look and what steps you’d need to take.
When you return to work too early then your insurer can claim that you were able to earn an income for a period of time after you claimed that you were disabled which could either decrease your payout, make it a partial disability, or more often turn into a full denial.
5. Psychiatric Conditions Aren’t Covered
From the wave of disability claims in the 1990’s physicians think that psychiatric conditions are not going to be covered or only covered for 2-3 years as their policy states.
This isn’t entirely accurate. If a physician’s medical problem leads to a psychiatric condition then that psychiatric condition will qualify you for life-time full disability, all things being equal.
6. Exclusion of Pre-existing Conditions
When I applied for my own private disability policy back in my working days I got denied for any future vision problems because I get a recurrent episcleritis condition.
According to my policy even if I went blind then I wouldn’t be eligible for disability income because of this preexisting condition. Well, this isn’t fully true. If I got a flash burn of my cornea then I could definitely still file a disability based on my vision alone.
7. It’s Not Just 1 Condition
By the time you got to file for disability there will be various conditions which all run into each other. Your back pain may cause insomnia. The medication you took may have caused chronic side effects. The chronic pain may have caused major depression, etc.
The point is that you shouldn’t take on the task of orchestrating your own disability claim and it’s better to get a lawyer involved really early on.
8. Sickness Doesn’t Count
If you’ve kept up with personal disability policies then you’ll know that almost all will state that a “sickness” will qualify you for only 2-3 years of payout.
A back injury might be a sickness. A pneumonia which left you with ARDS would be a sickness. But it’s not that simple. You may have already had back pains and then lifted a heavy patient and now caused something more permanent.
I need to do a whole post on how a physician should protect themselves in the workplace and it starts by writing every little incidence down.
When it comes to filing a disability claim you should keep every email or phone communication notes and documents from the point you purchased your disability policy up until you filed for the disability.
If the disability insurance underwriter gives you wrong information at the onset and you have documented proof of that then it will make filing your claim that much easier and potentially more lucrative.
10. Independent Medical Exam
When you file your disability claim the insurance company might nonchalantly ask you to undergo an independent medical exam.
The problem is that these exams are rigged and their IME physician is playing for the wrong team. If you don’t approach this situation cautiously then it’ll be as bad as walking into a medical board investigation interview unprepared.
Not only would it be advisable to secure legal counsel but it is even recommended that you attend such medical exams with your lawyer present.
11. Filling Out The Disability Claim Incorrectly
The application process for disability is laborious and you’ll be asked to answer various questions which are meant to help the insurance company deny your disability claim.
A common one is when you are asked what percentage of your work involves doing administrative work (paperwork, emails, etc.) and how much involves doing emails/phone calls.
The point of such questions is to show that your actual face-to-face time with a patient is only 20%. Which might be true. But you don’t want to jot that down on paper. The correct answer is often that 100% of your work is clinical work because your work is directly related to the patient’s clinical care.
12. Breach of Contract & Bad Faith
Somewhere along the line the insurance companies realized that physicians will grab ankle for anyone who asks. We’ll commit suicide before we ask for help. We’ll work well into our 70’s while the laws change around us without our input.
Since we weren’t willing to stand up for ourselves fortunately the gov’t did. A disability insurer must have the best interest of the insurer in mind (good faith). Of course in reality they don’t but they have to go through great lengths to hide that and your lawyer will be there waiting to point a finger.
Fortunately, if your lawyer can demonstrate a breach of contract or bad faith on the part of the insurance company then in most states you can file a lawsuit and get punitive damages on top of your disability income.
Every year there are multiple such cases and the insurance companies have learned to slow their roll. When you read the details of these cases then you realize how unfortunate the insurer is who got dragged around by the insurance company for years despite their debilitating MS or their spinal cord compression injury.
13. Know When To FIle
This is a harder problem to address but the stigma of disability and the tough-man attitude of physicians is a delightful barrier enjoyed by disability insurers.
Of course the data as to when to file comes mostly from legal groups who will benefit from you filing your claim early in your career and frequently. For the most part when your suffering affects your health, your well-being, and starts affecting the way you practice medicine then you should consider filing for disability.
Physician Disability Claims
Among physicians who file for disability the data is +/-5% but here is the breakdown that I was able to find as to what disabilities are being paid out b insurance companies:
- 25% of claims are musculoskeletal
- 15% neurological
- 15% psychiatric
- 5% diabetes related
- 5% respiratory problems
- 2% malignancy
You have a right to file for disability because your profession certainly doesn’t give a fuck about your well-being.
Your medical group will replace you if you drop dead or fall ill.
The medical board will come after you regardless of your good intentions.
Patients will sue you if you make a mistake bad enough to hold up in court.
As a physician you are likely to take a lot more shit than you need to throughout your career. It might be your good-willed nature but it might be your stubbornness and ego as well.
Know when to ask for help. Know when your medical condition is limiting your ability to do your work at the level you think you should be doing your work.
That disability insurance policy which you are diligently paying for every month will stab you in the back and do everything possible to deny you coverage when you need it. Be prepared and plan early.
You need to be prepared to file for disability before you ever need it. You need legal counsel early on and you won’t know what you don’t know but maybe your lawyer will.