Pain management physicians are board licensed doctors who have a substantial amount of training in pain management for patients. They review patient medical records, review x-ray and other diagnostic imaging results, interview patients, and work physically with patients. Sometimes, the work is diagnostic, and other times, it is aimed at developing treatment plans. Much of the time, these doctors work directly with patients who experience chronic pain. A pain management physician may need to work with a patient physically to determine the cause of a patient’s pain. These doctors often have long days and see and work with many patients every day.
When an injury occurs, it can be a back or neck injury from repeated joint stress or movement. This can mean a herniated disc in the back or neck. It can mean other joint damage. Entering patient notes either in hard copy form or on a computer can cause repetitive stress. Over time, this can cause arthritis or carpal tunnel syndrome making patient records and notes extremely painful.
Physicians also encounter a significant amount of stress, seeing and treating many patients over any given day. Stress can result in anxiety or depression over the long term. Stress can also result in physical symptoms, such as heart and vascular problems. Any physical or emotional condition that a physician may incur that prevents the physician from doing his or her work may result in a compensable disability. A physician who suffers a heart attack from work-induced stress may not be able to continue working. A physician who contracts Covid-19 and develops long-haul symptoms may be unable to perform their normal work duties either. Disability insurance coverage is meant to protect their income if they are unable to perform their duties.
Pain management physicians, like many other licensed health care professionals, often purchase disability insurance that is meant to replace the income that might be lost if they are unable to practice in their chosen specialty. These private insurance policies are often called “own” policies. This coverage requires that a pain management physician be awarded disability when the physician is unable to engage in their normal duties. Denials by insurance adjusters can be based on a hazy understanding of what a pain management physician does in their job. Other times, an adjuster denies a claim under an “own occupation” plan when the physician can work but is not able to work in their specialty because of a disability.
A disability insurance attorney in the Chicago area can help. Alternatively, denials of coverage may depend on how an insurance adjuster interprets the policy language. Doctors are often classified as “light work” occupations. That means that an adjuster may deny a disability claim on the basis that back or neck pain does not interfere with the physician’s ability to perform “light work” rather than looking specifically at what a pain management physician does and how the disability prevents the physician from that set of duties. Making this link is crucial.
Ferrin v. Aetna Life Ins. Co., 336 F. Supp. 3d 910 (N.D. Ill. Sept. 28, 2018) (holding insurance policy’s grant of discretionary authority is void under Texas law due to certificate being issued after effective date of regulation, and policy renewing after effective date, and holding Plaintiff was disabled from Any Reasonable Occupation where treating doctors certify she can sit at the occasional level, and insurer’s consultants opine Plaintiff can sit frequently, as weighing all evidence together would make capacity likely at low end of frequent range at best).
Sadowski v. Tuckpointers Local 52 Health & Welfare Trust, 281 F. Supp. 3d 710 (N.D. Ill. Dec. 20, 2017) (holding plan was arbitrary and capricious in denying medical benefits for removal of spinal cord stimulator following a fall down the stairs and infection where plan argued the expenses were caused by the same injury as the car accident necessitating implantation of the stimulator years earlier)
Tassone v. United of Omaha Life Ins. Co., 264 F. Supp. 3d 867 (N.D. Ill. Aug. 30, 2017) (awarding client long term disability benefits denied by United of Omaha despite insurer’s doctor opining there was no objective evidence of functional impairment)
Suson v. PNC Fin. Servs. Grp., Inc., No. 15-CV-10817, 2017 WL 3234809 (N.D. Ill. July 31, 2017) (holding Liberty Mutual’s denial of client’s long term disability benefits was arbitrary and capricious where Liberty Mutual disregarded client’s carpal tunnel syndrome and relied on a vocational opinion to which client never had an opportunity to address before litigation)
An attorney who handles disability claims in the Chicago area will know what evidence is needed to make the direct link between your disability and your inability to perform your daily duties and will know when an adjuster is speciously attempting to deny a claim.
We are here to help you, as we assist with many disability claims for Chicago professionals. Bartolic Law can help in the initial claims process, at the appeals stage, and beyond. We offer you a free case assessment to see what we can do to help, and you can book a consultation online. Every situation is unique. An insurance adjuster must see you as unique as well.