What Does Specialty Own Occupation Really Mean?

Transcription

1 What Des Specialty Own Occupatin Really Mean? Plicy definitins are cnfusing, nt nly t dentists but als t many f the insurance prfessinals wh sell them. Belw we will try t prvide an understandable explanatin f the different types f ttal disability definitins and hw they wrk. It is critical t understand that it s nt what the MARKETING MATERIAL says that gverns hw yur plicy defines ttal disability. It s what the plicy definitin says. Ttal Disability definitins d 3 things: Define what yur ccupatin is (this is where the Specialty language cmes int play). Define what criteria yu have t meet t be cnsidered ttally disabled frm yur ccupatin. Define what happens if YOU CHOOSE t return t wrk in anther ccupatin. First, let s define what yur ccupatin is. The best plicies define yur ccupatin as yur regular r wn ccupatin t age 65. This means the insurance cmpany cannt frce yu t wrk in sme ther ccupatin that they think yu are qualified t wrk in, if yu are ttally disabled frm yur wn ccupatin. Plicies that insure yur ability t wrk in yur ccupatin t age 65 are typically referred t as: Regular Occupatin (Reg. Occ) t age 65, Yur Occupatin (Yur Occ) t age 65, r Own Occupatin (Own Occ) t age 65. Yu shuld cnsider these names interchangeable. It s nt the term used that differentiates ne ttal disability definitin frm anther. It s hw the insurance cmpany writes the definitin f ttal disability. S read yur definitin f ttally disability carefully. Dn t assume yu understand what it means just because yur brker says yu have Own Occ t age 65. What is Specialty Own Occ? Specialty Own Occ further defines and narrws what yur ccupatin is. It means that fr purpses f defining what yur ccupatin is, the disability cntract specifically states yur ccupatin is yur dental specialty, assuming yu are a full time practicing dental specialist. If yu are a general dentist, then Specialty Own Occ means yur ccupatin is defined as general dentistry, instead f a sub-specialty. Mst insurance plicies d NOT include this specialty language. They make statements similar t the fllwing yur ccupatin is the ccupatin r ccupatins yu are engaged in at the time f disability. Is there a difference between these definitins? That s the millin dllar questin and it s a very cmplicated ne. Belw, are tw scenaris t illustrate this prblem. Example 1 Yu practice full time in a recgnized subspecialty f dentistry Yu are be ttally disabled frm yur dental specialty BUT

2 Yu ARE able t wrk in anther area f dentistry (general dentistry r a different subspecialty) and chse nt t. If yu have a plicy that specifically states yur ccupatin is yur dental specialty, technically, yu shuld be able t file a claim fr ttal disability, in the example abve. HOWEVER, hw realistic is this scenari? Dentists are surgens. Yu use yur hands and eyes. A bad back, arthritis, tremrs in yur hands, damage t yur eyes, heart prblems r sme ther medical issue that disables yu frm ne specialty in dentistry will disable yu frm all dental specialties, including general dentistry, which wuld make the abve example an interesting sales gimmick versus a valid benefit f Specialty Own Occ. There isn t a legitimate claims scenari where a dentist with a recgnized sub-specialty is ttally disabled frm that specialty but able t practice as a full-time general dentist. Furthermre, a cmpany with Own Occ t 65 can als cnsider yur dental specialty yur ccupatin, fr purpses f determining if yu are ttally disabled. Many f them claim t d exactly that. Hwever, if it s nt in writing, it s nt guaranteed. Example 2 Yu are practicing general dentistry and are ttally disabled frm seeing patients. Hwever, the insurance cmpany determines yu are able t get a jb ding claims cnsulting wrk with a dental insurance cmpany r teaching at a dental schl. The Specialty Own Occ definitin MIGHT declare yu ttally disabled but s might the Own Occ definitins withut the specialty language. Why isn t it guaranteed that yu ll be declared ttally disabled? In rder t be cnsidered ttally disabled under any definitin, the insurance cmpany wuld have t define yur Occupatin as being able t perfrm dental surgeries and see patients. If yu have that in writing, yu have smething imprtant. If yu dn t have it in writing, the insurance cmpany can take the psitin that yu culdn t get a jb teaching at a dental schl r cnsulting fr a dental insurance cmpany withut having a DDS r DMD. Therefre, thse ccupatins are within the scpe f yur ccupatin. S, is a plicy with Specialty Own Occ better than a plicy withut Specialty Own Occ? If yu have a subspecialty in dentistry and that is the ONLY DIFFERENCE in the tw cntracts, yes. It des prvide a mre narrw definitin f what yur ccupatin is, which is gd fr yu. Unfrtunately, the cmpanies that ffer Specialty Own Occ t dentists have ther weaknesses cmpared t sme f the carriers that ffer Own Occ t age 65 and they cst substantially mre (up t 50% mre). What criteria must yu meet t prve yu are ttally disabled frm yur ccupatin? Mst carriers state yu must be unable t perfrm the material duties r the material and substantial duties f yur ccupatin. The insurance cmpany reviews yur jb duties, at the time f claim, and identifies which f thse duties they cnsider material. If yu can t d any f thse duties, then yu are ttally disabled. What are the material duties f a general dentist r dental specialist? Certainly patient care functins and the ability t perfrm the dental prcedures f yur specialty are material. Are there ther material duties that a dentist might perfrm? It depends n what yu are ding at the time f claim. Are yu teaching 2 days a week r managing several dental ffices and

3 multiple dentists, which takes 25% r mre f yur time? If s, these duties culd be cnsidered material als, even by the cmpanies ffering Specialty Own Occ. S, if yu were ttally disabled frm perfrming patient care duties but culd still perfrm yur teaching and management duties (which yu were ding befre yu became disabled) wuld yu be cnsidered ttally disabled? Our pinin is yu wuld NOT. Yu wuld prbably cnsidered partially r residually disabled and paid based n the percentage yur incme was reduced. Hwever, depending n hw much yur incme was reduced, yu culd still cllect 100% f the benefit fr ttal disability. This will be explained shrtly. What happens if YOU CHOOSE t g back t wrk? There are 3 types f Own Occupatin t age 65 definitins. All 3 differ in hw they pay claims if YOU CHOOSE t return t wrk in anther ccupatin while yu are ttally disabled frm yur wn ccupatin. The Specialty definitin can be attached t any f these 3 definitins. True Own Occupatin t age 65 (True Own Occ) : This definitin f ttal disability says if yu are ttally disabled frm yur wn ccupatin and yu chse t wrk in anther ccupatin, 100% f the benefit is payable fr the entire benefit perid. Benefits are NOT reduced by incme earned in anther ccupatin. This is the definitin that insurance agents will tell yu is the best definitin f ttal disability. Why, because if yu are ttally disabled frm dentistry yu cllect full benefits, regardless f what yu d r hw much mney yu make. S, the true value f this definitin is it allws yu t make mre mney ttally disabled than wrking full-time as a dentist. This definitin is NOT available thrugh any Assciatin Grup Disability prduct we are aware f (including the ADA), even if their marketing material says it is. Is there a dwnside t True Own Occ? Yes cmpanies ffering True Own Occ t dentists limit benefits fr mental and nervus disrders (which include stress r stress related cnditins and typically substance abuse) t 24 mnths. Since stress related illnesses are ne f the leading causes f disability, this is a very imprtant restrictin. In additin, the True Own Occ plicies are als much mre expensive (up t 50% higher in premium) than the ther types f Own Occ t age 65 definitins. Mst Individual prducts available tday ffer Own Occupatin and nt wrking t age 65, assuming yu have an age 65 benefit perid. This is the best definitin we have seen in an Assciatin Grup plicy. This means if yu are ttally disabled frm yur ccupatin and YOU chse nt t wrk in anther ccupatin (the insurance cmpany cannt frce yu back t wrk in a new ccupatin), 100% f the benefit is payable t age 65. With mst f the Individual Disability Incme prducts, if YOU chse t wrk in anther ccupatin and earn less than 25% f what yu did as a dentist, 100% f the benefit is still payable. With mst f the Individual Disability Incme prducts, if YOU chse t wrk in anther ccupatin and earn mre than 25% f what yu did as a dentist, yur incme lss is calculated and that same percentage f yur ttal disability benefit is paid t yu. Mst Assciatin Grup plicies wrk in a similar fashin.

4 Example: If yu were ttally disabled frm practicing dentistry, wrked in anther ccupatin and had a 60% incme lss, then 60% f the benefit fr ttal disability wuld be payable. Yu must have at least a 20% incme lss t qualify fr this benefit. Transitinal Own Occupatin, t age 65 is a relatively new definitin. The difference between this definitin and Own Occupatin and nt wrking is, if YOU chse t wrk in anther ccupatin the Disability Benefit is NOT reduced unless yur benefit fr ttal disability plus the incme frm yur new ccupatin is MORE than 100% f yur incme befre disability. Example: If yur incme prir t disability was $20,000 per mnth, yur Disability Incme benefit was $10,000 per mnth, and yu were ttally disabled frm practicing dentistry and yu chse t wrk in anther ccupatin, yu culd earn up t $10,000 per mnth in the new ccupatin withut the Disability Incme benefit being reduced. Cnclusin Tday, plicies ffering dentists True Own Occ t age 65 limit benefits fr mental and nervus disrders (which include stress r stress related cnditins and typically substance abuse) t 24 mnths and have much higher premiums than plicies with Transitinal Own Occ r Own Occ and nt wrking. Since stress and stress related cnditins are ne f the leading causes f disability, ask yurself this Are yu better ff with a plicy with Transitinal Own Occ that pays benefits fr stress related disabilities t age 65, csts up t 50% less and des NOT reduce yur disability benefit unless yur incme plus yur disability benefit exceed 100%f hw much yu earned as a fulltime dentist (which is adjusted each year based n the change in the CPI) r a plicy that STOPS payments after 24 mnths fr stress related claims but, ptentially, allws yu t make mre disabled than wrking as a dentist, if it s nt a stress related claim? Is it even realistic t think if yu were disabled frm dentistry, yu culd find anther ccupatin that wuld generate enugh incme that when cmbined with yur Disability Incme cverage exceeded 100% f yur incme as a dentist? What peple frget is yu have t prve yu are ttally disabled frm dentistry fr any f this t matter. Things like heart prblems, cancer, neurlgical prblems, rheumatid arthritis, back prblems, r any ther serius and debilitating cnditin will, typically, keep yu frm pursuing anther ccupatin that pays a lt f mney. If yur incme is $20,000 a mnth and yu are carrying $10,000 a mnth f Disability Incme cverage, yu can earn $10,000 a mnth in a new ccupatin withut impacting yur insurance benefit (with Transitinal Own Occ ). Where d yu find a jb that generates $10,000 a mnth f incme, keeping in mind that yu have a serius medical prblem? If yu have the Own Occ and nt wrking" definitin, using the same example abve, yu can earn $5,000 a mnth withut impacting yur insurance benefit. What s imprtant is having Own Occ t age 65 s that the insurance cmpany cannt frce yu back t wrk in any ccupatin after a specific perid f time (typically 24 r 60 mnths f ttal disability). If yu want t pay the extra premium fr Transitinal Own Occ r True Own Occ d it. Hwever, NOT DOING IT des NOT mean yu ve made a huge mistake r that yur cverage is inadequate.

5 T make matters even mre cnfusing, the specialty definitin can be included in any f the three types f Own Occupatin definitins (True Own Occ, Transitinal Own Occ, r Own Occ and nt wrking). Example: Yu can have a plicy that has True Own Occ r True Specialty Own Occ r Own Occ and nt wrking r Specialty Own Occ and nt wrking, etc. The bttm line is Specialty Own Occ is anther ne f thse plicy prvisins that sunds sexy but, in the real wrld f dentistry, may nt be any different than Own Occ t age 65. S, it shuld NOT be the deciding factr in buying ne plicy ver anther. If yu ve stuck with us this lng, hang in there fr a few mre paragraphs. A few ther majr prduct differences Whether r nt the plicy pays benefits t age 65 fr mental and nervus disrders, which include stress and stress related disrders (we discussed this abve). The Catastrphic Disability Benefit (CDB), ffered by sme Individual Disability Carriers, allws yu t insure up t 100% f earnings, in the event yu are disabled by a catastrphic disability. Catastrphic disabilities are typically defined as disabilities that result in the inability t perfrm tw r mre activities f daily living, r the permanent lss f use f tw limbs, r speech, r hearing in bth ears r sight in bth eyes, r the disability is caused by a cgnitive impairment (e.g., Alzheimer s). Many plicies that were issued prir t 2006 d NOT cntain this rider. Benefit Update (BUR)/Future Increase Optin (FIO) riders are ffered by mst Individual Carriers. They guarantee that every 1, 2, r 3 years yu have the ptin f increasing yur benefit, regardless f yur health, if yu qualify financially. This prvisin is very imprtant fr dentists wh expect their incmes t increase significantly in the future. Mst cmpanies charge an extra premium fr these riders. Autmatic Increase Optin (AIO)/Future Benefit Increase (FBI) riders are ffered by sme Individual Carriers. They autmatically (n medical r financial underwriting) increase yur benefit by a stated amunt (typically 4% r 5%) r by the change in the CPI, fr 5 years. After 5 years, yu can renew the rider if yur current cverage des nt exceed what yu qualify fr based n yur incme. Mst carriers ffering this benefit charge an extra premium fr it. Disability Specialists, Inc. is the plan administratr. Yu can request a persnalized premium qute and receive the actual plicy definitins by returning t the Hme Page and clicking the Request a Qute buttn. If yu wuld prefer t speak with a Disability Specialists Advisr, call (888) (7:00 am t 4:00 pm Muntain Time). Just identify yurself as an assciatin member when yu call and yu will be given infrmatin n the prgrams in which yu are interested. Take the time t talk t a Disability Specialists Advisr and cmpare yur current cverage t the Principal Life plicy. It culd save yu premium dllars plus dramatically increase the amunt f benefit yu cllect if catastrphically disabled. This article is nt intended t be legal advice r a cmplete cmparisn f the prducts ffered thrugh the different carriers. Our intent was t pint ut the differences in sme f the mre imprtant definitins f disability. Our representatins are based n the plicy infrmatin we reviewed frm a variety f Individual and Assciatin Grup prducts. These representatins are nt binding t the insurance cmpany underwriting the prducts. The actual plicy prvisins will determine hw claims are paid.