A physician's group disability nightmare

My last operative day was October 15, 2009. My last attempt at getting to understand my group disability policy was on May 10, 2018. I’m a disabled anesthesiologist who lost his career when my left median nerve stopped functioning properly. I had two disability policies, a private and a group. My dealings with these two companies have been day and night.

My group insurance carrier hammered my dignity for years. In 2018, under ERISA law, I lost again, this time in federal court. For me, the end was bittersweet. Bitter because group disability companies do not have to tell you what will happen to your benefit when you begin to resume income sources. Sweet because during my ordeal, I exhausted every means of understanding my group disability policy. And now I get to teach what I learned in hopes of helping prevent this tragedy for other physicians.

My group disability provider would not assist me in understanding how my group disability policy functions when it comes to what happens should I generate income. Imagine yourself unable to use your hard-earned education to generate income. Imagine that, if you did earn income, you have no idea what would happen, unsure of the fiscal pain you might cause your family if you even tried. More than eight years is a long time for an anesthesiologist to be frustrated, anxious, and to live in fear that his income source is in doubt.

Anesthesiologists like certainty, really like certainty! I’m betting you like certainty, as well.

The more insidious part is how this company and other subpar group disability companies accomplish this.

Step one: The insurance carrier creates the contract — the policy. All disability policies are contracts. Legally speaking, they are unilateral contracts. That means one party generates or constructs the contract, and the other party accepts it or does not. Generally, when these unilateral contracts come to the courts, they are always interpreted “in the best light” to the accepting party and against the constructing party. In my opinion, and after attending business and law school, my group disability contract policy is a mess for a lot of reasons: missing wording (likely by simple construction error in my case), incongruent section references (purposely) and the worse part for me personally, the omission of calculating benefits affected by income (intentionally).

What can you do about it in your career life? Pay attention to your employer’s group disability provider. The group carrier may change the language and provisions every year during the anniversary of the policy. Read your policy. If you have difficulty with the language, have it reviewed by an independent disability insurance broker. What should you do about it ? Obtain your own high-quality individual disability insurance policy and work with your group to get a better group product.

Step two: Systematic avoidance of answering queries. A claims specialist gets assigned to you when you file a claim. In my specific case, a new specialist appeared about every 8–15 months. Envision yourself explaining everything again and again. I even got to talk with one “senior” claims specialist who promptly sent me an email, in error I believe, saying a settlement would be better for me — and then, it was redacted. A mistake, maybe, but its presence was psychologically and emotionally demoralizing for me. This broke me. Eventually, even the best of us give up or give in. In error or not, a settlement would have meant stability, certainty, and income security for my family. It would have made a huge difference in my mental health. The collective legal and expert conclusion(s): The only way to guarantee benefits under my group policy was to never generate any additional income. I was bringing home 57 percent of previous income, and nothing was going into retirement.

What can you do about if you find yourself a disability claimant under a group policy? You should retain an attorney the very first time you cannot get an answer to: “What happens if income is generated?”

Having utilized an attorney from that earlier point in time may have saved me years of frustration. Another thing — record all communications, including phone conversations from the very beginning. An attorney will do everything in writing with the company on your behalf, and it will all be recorded that way. Any required phone conversations should be recorded or occur in coordination with your attorney in their office.

Step three: The judicial system. ERISA law protects the insurance companies — not the claimants. While this is not really a surprise intellectually or even philosophically, it was difficult to understand emotionally and psychologically as a disability claimant with nowhere to get answers. The result is that my group disability insurance carrier really does not have to tell me what happens in my own policy should I earn income and ERISA law protects that company’s right to the omission of that information.

What can you do? Not much. ERISA law is from the 1970s and designed to protect insurance carriers. My advice, do not get in the situation where suing under ERISA law in federal court is your only option.

As a physician disability claimant, you’re stuck if you go on claim with a subpar group disability insurance carrier. Instead of the usual control, high level of understanding and professional communications you are used to in a medical practice, you get, well, you get what you get, and you’re stuck with it. I cannot fully express in writing the sheer frustration, anger, fear, disappointment, and anxiety that my group disability insurance company caused in my life. I have, however, learned, in great detail, how to teach my colleagues in the medical profession to avoid it. The worst part of the ordeal: While I was attempting to understand my policy and move forward with my life, dozens of physicians, my friends and colleagues were exposed to the same disastrous group disability product in my former group.