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Why First Responders Fire Fighters, ER Physicians and Nurses Should Read Their Long Term Disability Policies Carefully

First responders, such as firefighters, nurses, and doctors often have Long Term Disability Insurance included with a benefit package through their employer. Although people usually think this is a nice benefit, it most likely has significant limitations.

If your disability insurance is part of a group policy, it may be governed by the Employee Retirement Income Security Act of 1974. However, if your employer is a religious organization or a government agency (federal, state, city, or county) your policy is NOT governed by ERISA, rather by the laws of the state in which you reside. This makes a huge difference if you end up having a dispute with your insurance company.

A few important points to look for in your disability insurance policy:

Is it an OWN Occupation policy? Meaning you are insured for the occupation you are performing as of your date of the disability. For example, if you are an emergency room doctor as of the date you have an accident, that will be deemed your occupation. Or do you have an ANY Occupation policy? In which case you are only covered if you cannot perform ANY Occupation due to a disability. For example, if you are an ER doctor, the insurance coverage question is about whether you can perform the duties of ANY Occupation that you are fit for by reason of your education, training, and experience (e.g. any other kind of doctor). Sometimes, you might have a hybrid policy, where you have OWN Occupation coverage for two years, but thereafter, you are only insured for ANY Occupation. That means you are covered for the first two years if you cannot perform the duties of an ER doctor, but then if the insurer asserts you can perform the duties of ANY doctor, you lose your benefits.

If it is a hybrid policy, consider purchasing better coverage. A policy with OWN Occupation for life is the gold standard. That way you will be covered if you cannot perform your substantial and material duties of your OWN occupation in the usual and customary manner, with reasonable continuity. The biggest benefit is getting a policy that is not provided by your employer though.

You could even have both a policy from your employer and an independent policy you purchase yourself. Many of our clients have multiple policies from different insurance companies.

It is always good to review these policies before you actually submit a claim. There are many nuances in the policies about determining the amount of time you are working, the duties of your occupation, the procedures you are performing and how it relates to your benefits. For first responders, it is not uncommon that the duties of your occupation change by the time you become disabled. But remember, that is what defines your occupation.

Before you change your job duties, your work schedule, the procedures you perform, and the CPT codes you log, you may want to speak with an attorney or expert first, as these changes can alter your coverage dramatically.

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