Pharmacist Disability Benefit Claims & Tips For Getting Benefits Paid
Here at Disability Attorneys Dell & Schaefer, we’ve handled thousands of disability claims filed by pharmacists over the years, and have learned a few things during the process. Pharmacists’ disability claims have some unique challenges and nuances, from how the definition of “disability” is defined in the policy to what type of medical documentation the long term disability insurance company will accept as proof of disability. Many disability insurance carriers simply don’t understand the ins and outs of a pharmacist’s job, which can make getting your benefits seem like an uphill battle. Read on for some disability benefit claims and tips pharmacists can use to get their benefits promptly paid.
The definition of “disability” in your policy is important to understand.
The long term disability insurance policy’s definition of disability is one of the most critical pieces used to determine whether a specific pharmacist will qualify for disability insurance benefits. Many policies broadly provide that “disabled” means you can no longer “do your duties as a pharmacist” – which begs the question, what are a pharmacist’s duties? This definition isn’t limited to exactly how the pharmacist is currently doing their duties in their current location, but instead relies on a nationwide standard, or the “national economy” definition.
Relying on the national economy definition of disability can be risky, as the long term disability company is unlikely to fully understand the scope of your occupational duties. Pharmacists have demanding jobs that often require long hours, steady concentration, and long days spent on one’s feet, and most pharmacists’ long term disability insurance policies are group policies that don’t make allowances for a specific person’s work environment. Pharmacists also must be at the top of their game mentally at all times, between the potentially dangerous medications they work with and the fact that many physicians tend to defer to pharmacists when it comes to patient questions about drug interactions.
The change of definition from own occupation to any occupation results in many denials.
Initially, a long term disability insurance policy may provide benefits to a pharmacist who is unable to perform their “own occupation” using the nationwide standard. But over time, this definition may shift to an “any occupation” standard, providing continued benefits only if the pharmacist is too disabled to perform “any” occupation that fits their education and skill set. Because pharmacists often have tailored their medical documentation and other claim support to an “own occupation” definition of disability, the switch to an “any occupation” definition often results in claim denials.
Why is the transition from short term to long term disability sometimes challenged?
Most short term disability policies are administered by the disabled person’s employer. On the other hand, long term disability policies (except for Walgreens, which is self-insured) are paid by the disability insurer – and once this money begins coming out of the insurance carrier’s pockets, it has far more of an incentive to deny your claims. Even if most of these denials are successfully appealed, each claimant who stops fighting back means more money the insurance carrier gets to keep.
Strong medical documentation of your disability is required for a pharmacist to get approved.
Many pharmacist claimants have pain conditions that prevent them from working on their feet for a full 40 hours a week. For pharmacists in particular, this chronic pain can lead to cognitive difficulties; someone who is distracted by serious pain may not double-check the dosage or drug interactions, potentially leading to serious consequences. Unfortunately, many long term disability insurance carriers don’t seem to give appropriate weight to pain-created cognitive troubles.
Because there is not yet an objective way to measure how much pain a person is experiencing, the more objective medical evidence you can gather, the better. In other words, being able to provide an MRI that shows you have several bulging or ruptured discs in your spine will support your disability claim more than a physician’s statement that you’ve reported experiencing lower back pain. You may also opt for cognitive testing or memory tests that can show whether your memory or ability to multitask has been compromised.
What tools do disability companies use to determine the credibility of your complaints?
One of the greatest tools in your arsenal can be a series of neuropsychological tests designed to show the reliability of your complaints. Because pharmacists are intelligent and tend to start out at a higher-than-average level on these timed tests, showing how one’s skills have deteriorated – even if they’re still technically “above average” – can go a long way toward boosting your credibility.
But long term disability insurance carriers have their own arsenal of tools, not all of which are always known to the disability claimant. Most disability carriers use video surveillance and monitor claimants’ social media accounts, comparing the information they glean with what the claimant has already told them. If a claimant overstates the impact of their disability and is then observed driving for a long distance, working out, going to social events, or engaging in any other activities they claimed not to be able to do, their claim likely will be denied.
The long term disability insurance attorneys at Dell & Schaefer have seen every type of disability policy and worked with just about every disability insurance carrier out there. We have the experience and the expertise to work with your insurance company to see what it will take to get your benefits paid. For more information, please reach out to any of our disability insurance attorneys to schedule a free initial consultation to discuss your long term disability claim.
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Sedgwick
AT&T Was Great and Sedgwick Horrible
My Physician recommended that I take some time from a toxic environment after several deaths in my family coupled with AT&T trying to run tenured employees out of the door... read more >
New York Life
Keeps claiming they will not approve claim for pre existing conditions but my illness is not preexisting
I have been appealing a claim for LTD for 8 months! New York Life keeps claiming they will not approve claim for pre existing conditions but my illness is not preexisting ... read more >
Reliance Standard
Staff Lie
I had my disability cut off the day I was scheduled to find out whether I should have surgery. The claims examiner was aware that I had an appointment on that date and sai... read more >
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Hartford
Former Hartford employee has had life insurance and accidental death policy's revoked for one late premium payment
Dislike how they are constantly interrupting the lives of their disabled EE's whom are entitled to benefit which they paid into out of there pay check every pay period onl... read more >
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Lincoln Financial
Never received benefits my entire leave - or help with them
I used my short term disability insurance for maternity leave and started the process beforehand knowing when I would be out (scheduled induction.) It took a little over a... read more >
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Unscrupulous Tactics
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Sedgwick
Lame
My experience with Sedgwick and personell is as follows: Unhelpful, unprofessional and an overall unpleasant experience.
Unum
Low payments
I was injured at work. I did house keeping in a hospital. I tore just about everything imaginable in my knee. I was let go from my job, because I was no longer able to do ... read more >
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