The Fine Print Impacts Long Term Disability Coverage

Robert J. Fisher | 1.10.19

ByrdAdatto is grateful to have this article contribution from guest author, Lawrence B. Keller, founder of Physician Financial Services. Larry is highly regarded by physicians throughout the United States on disability policies and other insurance related products. Because this area is outside our expertise, this article does not express the opinions of ByrdAdatto and should not be construed as legal advice. If you have questions, please contact Larry directly or your insurance advisor.

The coverage provided under your policy, including the “Own-Occupation” definition of total disability, is portable from one job or occupation to the next. It is important to remember that your occupation at claim time is based on the main activities of your work immediately prior to the start of your disability.

Some companies will even go so far as to state that if you have limited your practice to a single medical specialty, that specialty will be deemed to be your occupation. This definition of total disability makes it possible for you to work in another occupation or medical specialty and still receive your full disability benefits – even if you are earning the same or more income than you were prior to your disability. There is no black letter law that states exactly when one will be considered totally disabled, residually (partially) disabled, or not disabled at all.

Generally, for surgeons, as long as, the occupational analysis showed that just prior to disability his/her main duties were performing surgery and the majority of his/her office based practice was pre-operative consultations and post-operative follow-up, they would be considered totally disabled and their new income is not taken into consideration and their full disability insurance benefits continued to be paid as he/she remains unable to perform the material and substantial duties of their occupation.

In their most recent offering, Berkshire’s policy starts with a true “Own-Occupation” definition of total disability and then adds a second way to qualify for benefits with a threshold that can be used in order to receive full disability insurance benefits if you are a surgeon or invasive practitioner by stating that “[i]f your occupation is limited to a Medical Doctor or Doctor of Osteopathy and more than 50% of income is earned from performing surgical procedures, we will consider you to be totally disabled even if you are gainfully employed in your practice or another occupation so long as, solely due to injury or sickness, you are not able to perform surgical procedures.”

This language changes the focus from solely your duties to your source of earnings and provides more ways to qualify for total disability benefits. Surgical procedures means the medical interventions involving an incision with instruments performed by you in a clinical or hospital setting normally involving anesthesia and/or respiratory assistance, that you regularly perform, during the 12 months prior to your disability. These procedures can be performed on either an inpatient or outpatient basis. Providing hypodermic injections, in itself, is not a ‘surgical procedure.’

If you have a mixed practice or your income comes from several sources, this can be an advantage as it stipulates that percentage of income that must be met in order qualify for total disability benefits.

Otherwise, as long as a policy contains an “Own-Occupation” definition of total disability, the carriers will all evaluate a claim in a similar fashion.  But keep in mind, an individual’s eligibility for benefits is determined on a case-by-case basis, taking into consideration the factual circumstances presented as well as the terms and conditions of his/her policy(ies).

If you have an occupational change, it is always a good idea to review your insurance coverage with your agent to make certain that your policy is still in line with your individual needs, goals, and budget.

Lawrence B. Keller, CFP®, CLU®, ChFC®, RHU®, LUTCF is the founder of Physician Financial Services, a New York-based firm specializing in income protection and wealth accumulation strategies for physicians.  He can be reached at (516) 677-6211 or by email to with comments or questions.

These are the personal views of the author and may not represent the views and opinions of The Guardian Life Insurance Company of America or its subsidiaries or affiliates thereof.

Individual disability income products underwritten and issued by Berkshire Life Insurance Company of America (BLICOA), Pittsfield, MA. BLICOA is a wholly owned stock subsidiary of The Guardian Life Insurance Company of America (Guardian), New York, NY. Product provisions and availability may vary by state.

Guardian, its subsidiaries, agents, and employees do not provide tax, legal, or accounting advice. Consult your tax, legal, or accounting professional regarding your individual situation.

Registered Representative and Financial Advisor of Park Avenue Securities LLC (PAS), 355 Lexington Avenue, 9th Floor, New York, NY 10017-6603, (212) 541-8800. Securities products and advisory services are offered through PAS, 1-516-677-6200. Financial Representative, The Guardian Life Insurance Company of America, New York, NY (Guardian). PAS is an indirect wholly owned subsidiary of Guardian. Physician Financial Services is not an affiliate or subsidiary of PAS or Guardian.

PAS is a member FINRA, SIPC.

2018-70929 Exp. 12/04/2020