• Refuse to cover children under age 19 who have a pre-existing condition
• Impose a lifetime limit
• Cancel a policy unless they can prove fraudulent information was given
• Fail to provide an appeal process for denied claims

Effects on Physicians

• Follow established clinical guidelines about return-to-play decisions according to recent state law. The physician is in the position of overseeing final return and by law is the only person permitted to release the student-athlete following a diagnosed concussive episode.
• Talk to parents of young athletes, encouraging them to look out for any head injuries—even seemingly minor ones—and be sure their child is examined by a physician before returning to the playing field. If you are a family physician or pediatrician, you should always be informed about any type of concussion, no matter how minor it may seem at the time.
• Have brochures and flyers on concussion prevention, diagnosis and treatment available at your office.
• Lobby to change the high school football rules to limit the violent hits. Urge young athletes—with their parents’ support—to use helmets for sports like bicycling, skiing and snowboarding.
• Train coaches and teachers on what red flags they should be watching out for and how to refer an athlete for evaluation. Coaches are often the first to see an impact that might produce a concussion. Classroom teachers may be the first to notice subtle differences in the student-athlete’s ability to focus, remember new information and get along with classmates.

• Become involved with local school districts. All community physicians, in addition to the team and school physicians, should be familiar with school personnel who work daily with the concussed student-athlete such as the certified athletic trainer, school nurse and school psychologist in order to ensure consistent and thorough care.

• Reach out to any well-known athletes you know, who, as role models, may be able to help deliver a powerful message about the potentially devastating effects of concussions and head injuries and the need for prevention.
• Find other ways to encourage your community to take the issue of concussions among young athletes seriously.

The most important first step any physician must take when beginning the process of selecting an individual disability insurance policy is educating themselves about the various inherent differences between each contract. Unlike term life insurance, which has a few obvious variables in which to analyze, disability insurance contracts, even within the same company, can have significant differences in how they pay you for a claim. Most reputable contracts will offer “own occupation” definitions of disability which pay a claim if you cannot work in your specific occupation – not just any occupation. However, not all own-occupation definitions are the same, and understanding the subtle yet important differences between each contract is critical to selecting the correct policy as a physician. By outlining the most common types of own-occupation definitions below, this should aid in the education process for selecting the most appropriate disability insurance policy.

For convenience, all types of own-occupation definitions outlined below are in order from the most to least comprehensive in nature. A clear relationship exists between the price of each contract and its definition. Disability insurance is a product which clearly follows the mantra that “you get what you pay for.” The better the definition of own-occupation, the more expensive the policy will be. Selecting which definition will provide the right fit comes down to an self-analysis of what your own level of risk tolerance is.

The most complete definition of own-occupation coverage on the market for physicians is called “true own-occupation” with included medical specialty protection language. Such a definition means that, because of a sickness or injury, you are not able to perform the material and substantial duties of your medical specialty (your occupation is the one in which you are engaged in at the time you suffer an injury or sickness). When you are disabled and receiving a benefit, you are still allowed to work and earn an income in another medical specialty as long as it’s not your original specialty. Furthermore, a few contracts will even offer sub-specialty protection allowing for designation of a few select procedures. This is very important because it allows physicians the choice of going back to work in the medical field and earning an income without jeopardizing the loss of their benefit from the insurance company. A typical example would be a cardiologist with invasive duties suffering an injury or sickness which prevents him or her from performing a select few surgical procedures imperative to their job. This definition would continue to consider them disabled even if they decided to practice in internal medicine and earn additional income. The amount of income earned from a physician in internal medicine would not affect their benefit.

The second choice available is a true own-occupation definition without medical specialty protection language. This contract shares the same language listed above without the medical specialty designation. This definition would pay a benefit if a sickness or injury prevented the proposed insured from working in their own-occupation as a physician. It would continue to pay the benefit if that individual chose to work in another profession outside of medical field (i.e. consulting, teaching, etc.) and the claim amount would not be reduced. However, it would not allow the choice of working as a physician in another specialty. Let’s use the same example above with the cardiologist. Under this definition, the policy would not allow the proposed insured the choice of receiving a benefit if they decided to start working again in the medical field (as a doctor in internal medicine). Since the policy language does not separate the occupation with medical specialty, the individual would be considered a “physician” and not a cardiologist in the eyes of the insurance company.

The third choice available is a “trans-own-occupation” definition. This form of coverage was created to help bridge the gap between pure own-occupation protection contracts and those with modified own-occupation definitions described below. This definition does not have medical specialty language, but will pay a benefit in the event a person cannot perform their duties as a physician (or other primary occupation). It will also continue to pay a benefit if that person decides to work in another profession, but will begin limiting that disability benefit if that individual’s new profession income, coupled with the benefit, adds up to more than their pre-disability income.

This concept is best understood through an example. A radiologist making 0,000 becomes disabled and goes on claim – receiving ,000 a month for a benefit. After not working for a period of two years, this individual decides to accept a position working as a consultant for a drug company and is given a salary of 0,000. Consequently, this means this person now is going to make 0,000 from their disability policy and 0,000 from this new job, totaling 0,000 in annual income – more than their previous salary as a radiologist. In this case, since the consultant salary oversteps the pre-disability income figure by ,000, the disability benefit will be reduced to level out the total income equal 0,000. In most pure own occupation contracts, this reduction would not occur.

The fourth choice available, and probably the most common definition found, is a modified own-occupation definition of disability. Such contracts would pay a benefit if the disabled person could not perform their specific occupational duties (as a physician) but would not continue to pay if that individual chose to be gainfully employed in another field. In other words, a benefit would only be paid if that person never went back to work again – in any profession.

The fifth choice available, and one that most employer-sponsored group plans utilize, is an adjustable modified own-occupation to gainful occupational definition. In such a plan, a person would be provided with a modified own-occupation definition of protection for the first two or five years of disability, but thereafter the definition would switch over to a gainful occupation. A gainful occupation definition means a sickness or disability must prevent a person from working in any occupation they are qualified to work in – not just their specific occupation. This means that the insurance company can revisit a person’s claim after that modified own-occupation period ends to see if that sickness or disability prevents them from working in any occupation – not just their own.

These broad differences between own-occupation definitions comprise only a small portion of options separating disability insurance contracts in today’s market. They do, however, outline the tremendous differences available for prospective buyers. The most prudent choice of which contract to purchase should be made once a clear understanding of the contract language has been made. Most physicians want to ensure protection of their training and education in the medical field by obtaining a policy that has a pure own-occupation definition with medical specialty language, but other physicians sometimes may not.

Make certain that, when comparing different forms of coverage, you comparing “apples to apples” with contracts that share the same definitions and contract structure. This will provide an accurate measure of competitive contracts vs. different contracts. Any pure own-occupation policy will be more expensive than a modified own-occupation policy because they are completely different policies. Finding the answers to such questions will ensure a proper selection is made for protection that is the single most important block of protection in your financial picture.

Thomas Lloyd is a financial representative specializing in disability insurance with the Guardian Disability Insurance Brokerage in Rockville, MD.

Obtain Medical Specialty Own-Occupation Disability Insurance On-line

• Cash Value earnings tax deferred
• Not correlated to Stock Market Results. Can serve as a hedge to diversify against market downturns
• Mutual Life Insurance Companies can provide a dividend to their policyholders, although this is never guaranteed
• Provides leverage to fund estate taxes for high net-worth individuals looking to minimize taxes for family heirs
• Cash Value can be accessed income tax-free through withdrawals and loans provided the policy stays in force* to help minimize the potential cost of higher tax rates on retirement distributions.

• Follow established clinical guidelines about return-to-play decisions according to recent state law. The physician is in the position of overseeing final return and by law is the only person permitted to release the student-athlete following a diagnosed concussive episode.
• Talk to parents of young athletes, encouraging them to look out for any head injuries—even seemingly minor ones—and be sure their child is examined by a physician before returning to the playing field. If you are a family physician or pediatrician, you should always be informed about any type of concussion, no matter how minor it may seem at the time.
• Have brochures and flyers on concussion prevention, diagnosis and treatment available at your office.
• Lobby to change the high school football rules to limit the violent hits. Urge young athletes—with their parents’ support—to use helmets for sports like bicycling, skiing and snowboarding.
• Train coaches and teachers on what red flags they should be watching out for and how to refer an athlete for evaluation. Coaches are often the first to see an impact that might produce a concussion. Classroom teachers may be the first to notice subtle differences in the student-athlete’s ability to focus, remember new information and get along with classmates.

• Become involved with local school districts. All community physicians, in addition to the team and school physicians, should be familiar with school personnel who work daily with the concussed student-athlete such as the certified athletic trainer, school nurse and school psychologist in order to ensure consistent and thorough care.

• Reach out to any well-known athletes you know, who, as role models, may be able to help deliver a powerful message about the potentially devastating effects of concussions and head injuries and the need for prevention.
• Find other ways to encourage your community to take the issue of concussions among young athletes seriously.