Recently, I was reviewing disability coverage with a client who was understandably focused on the first 90 days of a claim.
What happens during the waiting period?
When do benefits start?
How much will I receive?
All reasonable questions.
But as I went through the contract, I told him:
“The first 90 days aren’t what worry me. It’s month 13.”
Why?
Not because there is anything magical about month 13.
And certainly not because disability contracts commonly change after 12 months. In this particular client’s employer contract, month 13 was when something important changed on their contract.
That’s what concerned me.
And it is a good example of why I think we sometimes focus on the wrong things when evaluating disability insurance.
The Number on the Benefit Statement Isn’t Enough
Let’s say you are an ENT surgeon earning $500,000 per year and your employer provides long-term disability insurance.
The benefit summary says you have $15,000 per month of coverage.
Sounds pretty good.
And it may be.
But before I give you credit for having $15,000 per month of disability protection, I want to know more.
Is the benefit taxable?
Are there offsets?
What definition of disability do you have?
What does the contract consider your occupation?
And does the definition change at some point during a claim?
Those questions tell me a lot more than simply knowing the maximum monthly benefit.
Let’s Assume You Become Disabled
You are an ENT surgeon and develop a medical condition that prevents you from performing surgery.
You file a claim and meet the definition of disability under your employer’s contract.
You get through the elimination period and benefits begin.
Great.
The checks start coming.
Month 4.
Month 6.
Month 9.
Month 12.
Nothing about your medical condition has changed.
You still can’t perform surgery.
But under the contract I was reviewing with this particular client, something did change.
The definition.
That’s why I was concerned about month 13.
Your Medical Condition Doesn’t Have to Change for Your Benefits to Change
This is one of the more important things to understand about disability insurance.
Your medical condition can remain exactly the same while your eligibility for benefits changes.
Why?
Because the contractual definition of disability can change during the claim.
In the client’s situation that prompted this conversation, that happened after 12 months.
Other employer contracts may change after 24 months, at another point, or work differently altogether.
So don’t get hung up on month 13.
Find out what happens in your contract.
That’s the real point.
During the initial period, the carrier may be looking at whether you can perform your occupation.
Later, depending upon the contract, the standard may change and the carrier may consider whether you can perform another occupation based upon factors such as your education, training and experience.
Think about what that means for our ENT surgeon.
You still can’t perform surgery.
You haven’t recovered.
But the carrier may take the position:
We agree you can’t do what you were doing before, but we believe you are capable of doing something else.
Maybe you can consult.
Teach.
Work in administration.
Work in another medical capacity.
Potentially do something completely different.
Now what?
That’s the question I want answered while you are healthy.
“But I’m Still Disabled.”
You may be.
Medically, nothing may have changed.
You still can’t perform the duties that generated your income before the disability.
But an insurance company isn’t simply determining whether you have a medical condition.
It is determining whether you meet the definition of disability contained in their contract at that point in the claim.
That’s an important distinction.
And it’s why I don’t want to stop my analysis when I see that someone has a $10,000, $15,000 or $20,000 monthly employer benefit.
I want to know what you have to do to qualify for it.
And then I want to know:
What do you have to continue doing to keep it?
Own Occupation Isn’t Necessarily Own Specialty
There is another issue here that is particularly important for physicians.
If your employer contract says Own Occupation, don’t automatically assume that means Own Specialty.
It may not.
You may consider yourself an ENT surgeon.
The employer contract may look at your occupation more broadly as being a physician.
Those are very different things.
You may no longer be capable of performing surgery but still be capable of maintaining a medical license and working as a physician in another capacity.
How does your employer contract treat that?
Compare that with an individual disability policy containing a strong Own Specialty definition.
If you meet that contract’s definition of total disability because you can no longer perform the material and substantial duties of your medical specialty, you may potentially receive your full disability benefit even if you choose to work in another occupation.
Same physician.
Same medical condition.
Potentially very different outcomes.
This Doesn’t Mean Employer Disability Insurance Is Bad
I want to be clear about this because I think employer disability insurance can be valuable.
If your employer provides it, great.
I’m glad you have it.
The issue isn’t whether employer coverage is good or bad.
The issue is understanding what you actually have.
If someone tells me:
“I have $15,000 per month through work.”
My response isn’t that they need another $15,000 of individual disability insurance.
My response is:
“Let’s take a look at it.”
Maybe the employer coverage is ok.
Maybe it fills a significant portion of the need.
Maybe there are gaps.
Until I read it, I don’t know.
Find the Hole Before You Try to Fill It
This is really how I approach disability insurance planning.
I’m not starting with:
How much more insurance can we buy?
I’m starting with:
What do you already have?
Then we figure out where the holes are.
Maybe the problem is the waiting period.
Maybe benefits are taxable.
Maybe there are offsets.
Maybe the monthly maximum leaves a significant income gap.
Maybe Own Occupation doesn’t mean what you thought it meant.
Or maybe everything looks pretty good initially, but the definition changes later in the claim.
That’s why reading the contract matters.
The number on the benefits statement tells me what you could receive.
The contract tells me what has to happen for you to receive it and what has to continue happening for you to keep it.
So Why Am I Talking About Month 13?
Because for one particular client, that was where the hole was.
For you, it may be month 25.
It may be somewhere else.
Or your contract may not have the same issue at all.
That’s exactly why I don’t want to assume.
Yes, I want to know what happens during your first 90 days.
But then I want to keep reading.
What happens six months into the claim?
A year?
Two years?
Does the definition change?
Do offsets change?
What happens if you still can’t perform the work that produced your income but the carrier believes you can do something else?
From Scott & Amber’s Desk
Find that point in the contract.
Because when it comes to disability insurance, getting a benefit started is obviously important.
Understanding what it takes to keep that benefit may be even more important.
Every article in the MD Disability Quotes Knowledge Center is written with one purpose: to help physicians understand insurance contracts before they ever need to rely on them.
About MD Disability Quotes
MD Disability Quotes is a nationwide disability insurance advisory firm specializing in income protection for physicians, dentists, business owners, and other high-income professionals.
Founded by Scott Nelson-Archer and Amber Stitt, the firm brings nearly 40 years of combined experience helping clients evaluate disability insurance contracts, navigate underwriting, and design income protection strategies tailored to specialized careers.
Scott and Amber are the longest-tenured disability insurance experts featured by White Coat Investor. Their education-first approach has helped thousands of physicians better understand disability insurance throughout medical school, residency, fellowship, and practice.
Whether you’re reviewing an existing policy or exploring coverage for the first time, MD Disability Quotes is committed to helping you make informed decisions that protect your ability to earn an income.
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