A Definition that matters:
Own Specialty/Sub-Specialty
The most important questions you can ask about your Physician Group LTD policy are these: “Does
it protect the income I make in the specialty or sub-specialty I am practicing in? Or does it merely
protect my ability to work as some type of physician?” The definition of disability is the key to
unlocking the benefits of a specialized Physician Group LTD policy.
DEFINING DISABILITY
Consider this actual scenario. An Emergency
Room physician was disabled with diabetic
neuropathy and arthritis. Her LTD carrier’s broad
definition of disability, called Own Occupation,
meant that although she could not perform her
specialty, she could still perform as a physician
in general and thus could be denied disability
status. Because she could not stand for extended
periods in the Emergency Room, the carrier
determined she was unable to perform all of
the material duties of her specialty, and paid
the claim for the first two years. After two years,
however, the claim was terminated because the
LTD carrier determined the she could perform
as a physician in general.
For many physicians who specialize in a given
field of medicine, this disability train wreck—
for lack of a better phrase—is a likely and
unfortunate scenario. Most physicians assume
their occupation is exactly what have been
trained for, certified in, and perform every day.
But how a physician group LTD policy defines
occupation is at the very heart of a disability
policy, and if the language does not specify
that your occupation is your sub-specialty, then
it is almost certain you will not be fully covered
in your sub-specialty. In the real-world scenario
described above, only a policy that offers an
Own Specialty/Sub-Specialty definition of
disability would consider this ER physician to
be totally disabled, and would not require her
to return to work in a different capacity.
YOUR PHYSICIAN GROUP LTD POLICY SHOULD BE
SPECIFIC … VERY SPECIFIC
If you are a specialist, your LTD policy needs to
define your occupation – the specific duties that
you perform every day -- as Own Specialty/SubSpecialty. Many policies define occupation as
Medical Doctor, meaning the LTD carrier can
force a physician back to work in a different
capacity as some type of medical practitioner.
At a minimum, your policy should factor in the
specific duties being performed by a physician
over the 12 months prior to disability, and use
these duties as part of the determination of a
claimant’s material and substantial duties.
WATCH YOUR STEP: THREE THINGS TO AVOID
1. Some LTD carriers recognize few specialties or
sub-specialties. Be cautious if your LTD carrier
has an Own Occupation definition and uses the
Department of Labor’s Dictionary of Occupational
Titles (DOT) list of occupations. Although the
DOT covers virtually every occupation in the U.S.
economy, it lists fewer than 10% of the recognized medical specialties and subspecialties. If
your specialty is listed, consider yourself lucky.
2. Some LTD carriers require Board Certification
and specialty-specific income. Although your LTD
carrier may have an Own Specialty definition, it
may require Board Certification and may also
require that more than 50% of your income
comes from that specialty within the past two
years. This definition is
problematic for newer,
not-yet-certified physicians.
3. Some LTD carriers do not recognize sub-specialties. Even though an LTD carrier may have an
Own Specialty definition, it may not recognize
sub-specialties. Such a limited definition is problematic for physicians whose sub-specialty
requires certain skills different from those needed in that specialty. For instance, consider interventional radiology, which is a medical sub-specialty of radiology that uses minimally invasive
image-guided procedures to diagnose and treat
diseases in nearly every organ system. Radiology,
on the other hand, is a medical specialty that
uses imaging to diagnose and treat disease seen
within the body. A sub-specialty definition protects the interventional radiologist in the event of
a disability, even though he or she may be able
to perform the duties of a radiologist.
THE RIGHT STUFF
It seems right to consider what a physician has
been doing when determining disability status,
not what that physician might be able to do.
How a physician group LTD policy defines your
occupation is crucial to receiving any disability
benefit at all.
Group disability insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all
states, except New York under policy form 93P-LH. In New York, group life and disability insurance policies are underwritten
by Sun Life and Health Insurance Company (U.S.) (Windsor, CT) under policy form 13-GP-LH-01 and 13-LTD-C-01.
Administration for physician products is provided by Medical Group Insurance Services, Inc. (MGIS), in all states, except
as follows: in CA by MGIS Insurance Agency, Inc; in NY by MGIS Insurance Agency. Product offerings may not be available in all states and may vary depending on state laws and regulations. Sun Life Financial and the globe symbol are
registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us. For producer use only.
GGEL-PHY-4902SLPC 26313 12/14 (exp. 12/15)