The 10 Biggest Legal Mistakes Physicians Make When Filing a Claim for Disability

By Edward O. Comitz, Esq.


Executive Summary

The significant increase in physician disability claims over the past several years has caused insurers to scrutinize the terms of their policies and any claims made under them more closely and to use novel and creative theories when denying benefits. At the same time, insurance companies are attempting to increase revenue by significantly raising premiums on new policies, which provide far fewer benefits than policies issued less than a decade ago. Because physicians are no longer a targeted group for disability insurance sales, insureds should familiarize themselves with their policies and the claims process, and continue paying premiums on any policies that they may have purchased through the early 1990s. Since physician claims are scrutinized closely, it is critical that the following mistakes are not made during the claims process.


Mistake 1            Failing to Consult With Counsel

Mistake 2            Misunderstanding the Definitions of “Disability” and “Occupation”

Mistake 3            Inadequate Documentation

Mistake 4            Blindly Attending an Independent Medical Exam

Mistake 5            Believing All Mental Conditions Are Excluded or Subject to Limitations

Mistake 6            Engaging in Inadequate Communication With Treating Physician

Mistake 7            Quantifying Time

Mistake 8            Ignoring the Possibility of Surveillance

Mistake 9            Blindly Accepting That Subjectively Diagnosed Conditions Are Not Covered

Mistake 10          Tossing Out Application, Policy, and Claims Documents


The above has been excerpted from the SEAK text, The Biggest Legal Mistakes Physicians Make and How To Avoid Them.