Last week we had a general surgeon call us about a skiing accident he just had. He was getting off the gondola and walking to the slopes when he slipped on a piece of ice. As he fell, he caught his thumb on the edge of his ski and suffered nerve damage.
This general surgeon is now unable to do surgery for the foreseeable future. So the question is, “How will my disability policy work now that I need it?”
The contract language will determine if the policy he bought pays everything, some, or anything at all. This surgeon actually had several policies: one through me, one through a national medical association, and a group policy. While he thought he had an own occupation definition on all 3 of them, that is not exactly what we found.
While he thought he had an own occupation definition on all 3 of his policies, that is not exactly what we found.
With the Association plan, he did not qualify for coverage since he has a clause in the waiting period that states he has to be Totally and Continuously out for 90 days before benefits start. The plan did not consider him Totally disabled because he could still consult with patients even though he can’t perform surgery.
On the group policy, he has a 180-day waiting period so he wouldn’t get claim dollars rolling in until May. That is a really long time to wait, but he would be eligible since he does not have the words “Total” or “Continuous” in his policy. However, even though he has an Own Occupation clause in this policy, it limits him to both not working in another occupation as well as being unable to do ANY job for which he is reasonably trained, educated OR experienced after 24 months of claim.
Finally, on the policy design we put in place, he does not have a Total or Continuous clause in his policy, he does not have a time limit on his true own occupation / own specialty definition, and he does not have any benefit reduction for working in any other occupation.
My point here is words matter, design matters, and full understanding of the policies matter.
Give us a call and we will work with you to understand your goals and make sure the design/policies you are buying will perform to the standards you are wanting.