By: David Cairns, Associate Director, LTD Claims, Sun Life
The physician market continues to evolve and there are three key drivers to understanding their disability income needs. First, physicians and other healthcare professionals often work past typical retirement age which requires specific language in the disability contract to ensure coverage. Second, physicians are highly committed to their patients, often returning to work in limited or reduced capacity. Both of these are good for the communities they serve in a time when physician access is challenged. And third, the nuances of physician duties and compensation require specialized knowledge, distinct from those of individuals in other occupations.
As an 18 -year industry veteran and claims leader at Sun Life, I can attest to how important it is to have a strong policy and understanding of physician compensation structure to ensure the proper total monthly earning (pre-disability earnings) definition is elected and accurate. This is important for physician group HR leaders and for the benefits representatives who help match physicians – whether they are in a group office or a hospital -- to a choice carrier.
In the event of a partial disability claim, having the accurate total monthly earnings definition is crucially important when comparing to disability earnings (current monthly earnings).
Physicians may be compensated based upon production and may not receive payment for a month or more after the services are rendered. If this is not considered in the policy, it could mean the difference of satisfying the elimination period and receiving an LTD benefit at the anticipated timeframe and benefit amount or experiencing a delay.
A typical group policy will have a return-to-work provision within partial disability of 12-months and then calculate benefits based upon a proportionate loss formula.
Given our overall experience and knowledge within this segment, we have recognized that a longer return-to-work provision of 24-months has allowed for a greater and sustained return-to-work efforts and overall success. Thereafter, for physicians who remain disabled at the two-year mark, we utilize a “best of both worlds” benefit calculation, proportionate loss or 50% formula. Whichever produces the highest LTD benefit is what is issued.
Claims philosophy in action – Work is Healthy (WisH)
Physicians and other healthcare professional have a deep commitment to their patients and want to return-to-work as quickly as possible. My team and I are committed to delivering on our promise. At each opportunity throughout a member's journey, we collaborate with physician members on claim to assist in any potential return-to-work and/or stay-at-work efforts, leveraging policy provisions and Vocational Rehabilitation Consultant support.
Example: A physician is diagnosed with a significant neurological condition. The LTD claim was approved as the physician was unable to perform one or more of the actual procedures she normally performed during the 12 months prior to disability. During the claim review, we recognized that the physician wanted to return-to-work and needed assistance. Our Vocational Rehabilitation Consultant (VRC) discussed a potential modified return-to-work that involved telemedicine, a flexible schedule, and ergonomics. The physician had been in touch with her employer and had started the process of requesting a part-time return-to-work. Our VRC was able to help coach the physician in working with the employer’s Accommodations and Ergonomics department for a transitional return-to-work plan. The physician returned to part-time work at 12 hours per week and participated in strategies to reduce fatigue and discomfort along with ergonomic solutions. Through proactive claims management, and support from the VRC, we were able to further assist the physician in her return-to-work efforts, address concerns and challenges of returning to full-time work.
In four months, the physician gradually increased her hours each month until returning to full-time work in an accommodated position with the employer.
As the physician market continues to evolve, we have a steadfast approach in reviewing and evaluating our product offering. It serves all of us well to find creative solutions that help physicians who aspire to work, to overcome obstacles and continue to serve their communities.
In all states except New York, group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA). In New York, group insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI).
LTDWB-10223 #1371890232 6/24 (exp. 6/26)
