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Your insurance company and the stated terms of your physician disability insurance policy define a “covered disability” and those conditions which are excluded from coverage. Medicare disability is attached or linked to the SSDI (Social Security Disability Income) program and follows their guidelines, benefit levels, and definitions.
Claims examiners employed by doctor disability insurance companies normally make the final decision as to covered disability and your eligibility for benefits. They usually consider physician reports, results of medical tests, conditions at the time of the injury or sickness, and any supporting information available. Should an examiner conclude your disability is not covered by the terms and conditions of your policy, you often have the right to provide more information that supports your claim and to request a review.
To avoid future problems, try to learn exactly how your insurance policy defines disability. If you suffer an injury or sickness that might be questionable, or if there may be a question if your injury or sickness has caused you to be unable to perform the duties of your specialty, you should be prepared to present complete information that validates your position.
Refer to your insurance policy contract for specific information regarding your coverage and for actual terms, conditions and exclusions. The above statements are general in nature and may or may not reflect the actual terms of your insurance policy.
|Jennifer Mathes, Ph.D.|