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What You Need to Know About Disability Insurance and Mental Health

Disability insurance provides financial protection for physicians when medical or mental health conditions affect their ability to work. In this blog, we cover key aspects of disability insurance for mental health, including covered conditions, qualification criteria, own-occupation coverage, and the claims process, ensuring you’re well-informed about your options and protections.

Understanding Policy Definitions

When considering disability insurance as a physician, it’s crucial to be aware of the specific mental health conditions that are commonly covered under such policies. These conditions are often recognized due to their prevalence and their significant impact on an individual’s ability to perform their work duties.

Mental Health Conditions Frequently Recognized by Disability Insurance

  • Depression: A pervasive mood disorder that can lead to persistent feelings of sadness and loss of interest, affecting daily functioning.
  • Anxiety Disorders: Including generalized anxiety disorder, panic disorder, and social anxiety, which can be severely debilitating.
  • Bipolar Disorder: A brain disorder that causes unusual shifts in mood, energy, and activity levels.
  • Schizophrenia: A chronic and severe mental health condition affecting how a person thinks, feels, and behaves.
  • Post-Traumatic Stress Disorder (PTSD): A condition triggered by exposure to a traumatic event, leading to intense, disturbing thoughts and feelings.
  • Obsessive-Compulsive Disorder (OCD): Characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions).

Criteria Used to Qualify for Coverage

Disability insurance providers typically look for several key factors when determining whether a mental health condition qualifies for coverage. These may include:

  • The severity of the condition and its impact on your day-to-day functioning
  • Duration of the condition and its long-term prognosis
  • Treatments undertaken, such as medication or therapy, and the response to these treatments
  • Documentation from qualified healthcare professionals validating the disability

How Mental Health Conditions Impact a Physician’s Ability to Work

Mental health conditions can significantly impact a physician’s capability to deliver effective care. Depression and anxiety, for instance, may affect concentration and decision-making, while conditions like OCD or PTSD might interfere with daily work routines and patient interactions. Disability insurance for mental health serves as a safety net by providing financial assistance during such challenging times.

Explore our disability insurance services to learn more about how we can support you on your journey toward comprehensive coverage and peace of mind.

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Knowing Your Coverage Limitations

Not all disability insurance policies are created equally. Many insurance plans have specific limitations or exclusions that can affect coverage for mental health conditions.

Benefit Period Caps

One common restriction is a capped benefit period for mental health-related disabilities. Unlike physical disabilities, which might be covered until retirement age, mental health conditions are often limited to shorter time frames, such as a two-year maximum. This means the insurance company will only pay out benefits for mental health claims up to the specified period.

Exclusions in Coverage

The fine print of your disability insurance policy may also include specific exclusions for certain mental health conditions. It’s essential to read your policy carefully to understand which mental health issues are covered and which are not.

  • Look for language regarding conditions that might be excluded entirely or have limited coverage.
  • Be aware of whether your policy includes a pre-existing condition clause, which may affect coverage for mental health issues you’ve previously been diagnosed with.
  • Note that substance abuse disorders may be treated differently than other mental health conditions in terms of coverage.

Understanding these limitations is key to ensuring that you have the appropriate coverage for your needs. If you’re uncertain about the terms of your disability insurance policy, consider consulting with an experienced insurance expert who can help clarify your coverage and advocate for your mental health needs.

Own-Occupation Coverage for Mental Health

Own-occupation insurance is designed to provide benefits if you cannot perform the specific duties of your designated profession due to a disability. For physicians, this means that if a mental health condition makes it impossible to carry out the tasks associated with your medical specialty—be it surgery, anesthesiology, or any other field—your policy would kick in, even if you might still be able to work in a different medical area or in another capacity altogether.
This is particularly beneficial for specialists whose extensive training is focused and cannot easily be transferred to another field without significantly impacting earnings.

Own-Occupation vs. Any-Occupation Coverage for Physicians

To put the value of own-occupation coverage into perspective, let’s contrast it with any-occupation disability insurance for mental health. An any-occupation policy only pays out if you’re unable to perform duties of any job for which you’re reasonably qualified, taking into account your training, experience, and education. For a physician with mental health issues, this can create a challenging situation where, despite being unable to continue in their current specialty due to their condition, they may not receive benefits because they could, in theory, work in a less demanding medical role.

Understanding the Claims Process for Mental Health Disability

Filing a disability insurance claim due to a mental health condition starts with knowing the ins and outs of your policy. Here’s a simplified roadmap:

  • Review your policy to understand specific coverage and any exclusions or limitations related to mental health.
  • Consult with your mental health professional to discuss your situation and the impact on your work ability.
  • Obtain the necessary claim forms from your insurance provider.
  • Complete the forms with accurate information about your mental health condition and its effects on your job performance.
  • Collect detailed documentation from your healthcare providers, including treatment plans, diagnosis details, and progress notes.
  • Submit your claim forms and documentation per your insurance provider’s instructions.
  • Follow up regularly with the insurance company to ensure your claim is being processed and to provide any additional information required.

The Role of Documentation and Healthcare Provider Information

Documentation is critical in supporting your disability claim. Comprehensive records from your healthcare provider illustrate the severity of your mental health condition and its functional impact on your daily working life. Ensure all forms are completed in detail, and medical evidence is substantial to avoid delays or claim disputes.

Challenges in Demonstrating the Impact of a Mental Health Disorder on Job Performance

Unlike physical disabilities, the effects of mental health disorders on work performance may not be as visible, which can complicate the claims process. Describing the functional limitations you experience and how they specifically hinder your job duties is crucial. Providing examples and clear explanations aids the insurer in understanding the necessity of your claim for disability benefits.

Navigate Disability Insurance and Mental Health With PRS

Physician’s Resource Services offers invaluable assistance for physicians exploring disability insurance and mental health. Our seasoned professionals are adept at guiding medical practitioners through the complex landscape of disability insurance, ensuring they secure the right coverage for their needs.

Reach out to PRS for experienced guidance and support in navigating the intricacies of disability insurance and mental health.

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Robin Bales – AGENT

Robin has owned a Commercial Leasing Company providing financing to doctors and other operators for their equipment beginning in 2007. After the global crash of 2008, she went to work for NYL and spent 3 years there working with other entrepreneurs securing their retirement future and safeguarding their personal asset risks. Robin opened her own agency in 2017 Legacy by Design and has run a national firm coast to coast with 50-70 agents. Today the agency is much smaller serving 5 agents who share the same vision and passion for our clients focusing on health insurance, Medicare, and annuities.

Robin is most connected to ethos of PRS mission to improve the lives of doctors and their families. Supporting those who run the leading infrastructure of our country.

Robin has been married for 22 years to her husband Steven. Together they have 3 girls and have built a family with strong values and commitment to each others successes. Robin’s family are home bodies by nature and enjoy their 3 dogs hanging in living room or kitchen.

Karli Allen – HEAD OF WEALTH MANAGEMENT

Karli is a graduate of The Master’s University in Santa Clarita, CA, and has a business degree with emphases in accounting, finance, and management. Karli has been in the financial services industry since 2014 and joined the PRS team in 2018.

Karli oversees investment and financial planning operations and assists with the onboarding and service of the firm’s advisory clients.  Karli was a key part of our firm’s custodial transition to Fidelity in 2019 as part of our decision to become an independent investment advisory firm.  Before joining PRS, Karli worked in personal financial planning in Orange County, California.  She also holds a FINRA Series 65 license. Karli is grateful to be a part of such an amazing team.

Outside of work, Karli enjoys traveling, playing golf, and spending time with her husband and their goldendoodle.

Gabriela Chavez – ANALYST

At Physicians Resource Service Gabby plays a pivotal role in Paul’s advisory team, staying in close contact with clients, driving business development, and lending a hand in daily operational tasks. Additionally, she collaborates with CPA Erin Anderson to prepare tax returns, conduct withholding reviews and undertake various tasks across the division.

Gabby is currently double-majoring in accounting and finance at the University of the Incarnate World in San Antonio, and she plans to sit for her Certified Financial Planning exam in the fall of 2022. Before transferring to UIW, she attended the University of Texas Rio Grande Valley in Edinburg, Texas. Gabby was born in Germany and is Mexican American. She loves to travel and has visited 11 different countries. She has a five-year-old pug named Penny.

Chris Fullbright – FINANCIAL ADVISOR

Chris brings experience in financial services and the perspective of a successful entrepreneur who has launched several businesses. With over a decade in the industry, he has served as both an advisor and in a management role coaching new advisors. Chris attended the University of Georgia and Texas State University and graduated with a Bachelor of Applied Arts and Sciences.

He currently holds many financial services licenses and designations including FINRA Group One, Series 6, Series 63, Series 65, Series 7, ARPC, and Certification in Long Term Care (CLTC). In his free time he enjoys being involved in the local community through organizations such as Comfort Crew for Military Kids. Chris is also an active member of Austin Christian Fellowship Church, and enjoys spending time there as well as reading, fishing, and going to sporting events. He is happily married to Monique with two wonderful sons. In addition to serving physicians, Chris specializes in working with special needs families.

Kevin Burris – PARAPLANNER

Kevin received his BA and MBA from Indiana University, earned the Certified Financial Planner (CFP) designation from the University of Georgia, and Retirement Income Certified Professional (RICP) designation from the American College. Kevin is looking forward to helping physicians live their best life. Kevin enjoys spending time on the lake with his wife, playing golf, and watching Indiana University sports.

Michael Kohles – AGENT

Michael attended Lake Michigan College and Siena Heights University, graduating magna cum lade with a Bachelor of Business Administration, with a major in Finance and minor in Marketing. Michael has been in the financial services industry since 2015 and has experience with multiple insurance verticals. Michael is excited to help physicians achieve their financial goals by providing insurance solutions. Michael is married to Erin and has 4 children. Michael also enjoys reading, golfing, playing poker, learning, and traveling.

Erin Kohles – UNDERWRITING PROCESSOR

Erin supports our advisors and clients during the insurance underwriting process in multiple ways. On a given day, she helps by processing applications, tracking and following up on open cases, and answering client questions. She appreciates the part she plays in helping clients prepare for the future, and she strives to make the process as simple and efficient as possible.

Erin has been in the insurance industry for two years and brings with her six and eight years of experience in accounting and quality control, respectively. She graduated from Ball State University and has her life & health and property & casualty insurance licenses. In her free time, she enjoys cheering on her two boys who play basketball, soccer, and baseball; traveling with her husband; and playing with their Yorkie, Mingo.

Erin Anderson – CERTIFIED PUBLIC ACCOUNTANT

As a certified public accountant, Erin is a valuable part of our tax division at PRS. She enjoys working with our advisors to develop tax-efficient strategies, and she strives to provide clarity for every client she serves. Erin started her career as an accountant after graduating from Oklahoma State University in 2012 with a master’s degree. She earned her CPA license in 2018. Erin and her husband have two little boys, and they love spending time outdoors as a family and watching OSU football.

Alex Simmons – BUSINESS DEVELOPMENT

Alex oversees Business Development at Physician’s Resource Services. She works with each department to assist in continually improving PRS so we remain a leading competitor in the industry. Alex graduated from Texas Tech University with a Bachelor of Business Administration in Energy Commerce. She is a Texas native who loves to spend her free time traveling and taking her pup, Teddi, to the dog park.

Jennifer Khan- UNDERWRITING SPECIALIST

Jennifer is an Underwriting Specialist at Physician’s Resource Services, with an extensive background in customer service and administration. Jennifer grew up in Texas, graduated from Southeast Missouri State University with a BFA in Theatre, and spent six years in Chicago performing sketch and improv. She is a graduate of the Conservatory Program at The Second City and iO Chicago. Jennifer and her husband, Qamar, moved to Texas with their dachshund mix, Dobby, to be closer to family, sunshine, and good BBQ.

Cheryl Breeden – OFFICE MANAGER

Cheryl is the Business Manager for the firm and a licensed service assistant. She graduated from the University of Texas at Austin with a Bachelor’s Degree in Business Administration. She has years of experience in the areas of process management, customer service, benefits, and insurance. Cheryl has three girls — Ashley, Hannah, & Olivia. She brings this experience to our firm where she manages the underwriting and service process. She also manages the business operations for the firm.

John C. Jackson IV – ASSOCIATE FINANCIAL CONSULTANT

John is an agent from Austin, TX, a graduate of Westlake High School and The University of Texas at Austin, with a Bachelor’s Degree in Economics and a Minor in Business Administration. While at UT, John was a 2-Time Captain and 4-Time All-Conference performer for the men’s lacrosse team. While away from the office, John coaches with the Westlake Youth Lacrosse program and volunteers with Austin’s Young Men’s Business League, and Austin Sunshine Camps.

Paul Smith, CFP® ChFC® MSFS – FINANCIAL ADVISOR

Paul has helped his clients in financial, business, and estate planning for over 10 years. Paul is a graduate of Texas State University, with a Bachelor’s Degree in Psychology. He has also completed the extensive studies necessary to earn the Certified Financial Planners (CFP®) and Chartered Financial Consultant (ChFC®) designations. Paul is actively involved in the community through his volunteer work and service on Community Action Board for the Helping Hand Home for Children. Paul is married to Heather and they have two children, Nyla and Hazel.

Richard Cunningham – MANAGING DIRECTOR

For 30 years, Richard has been helping clients reach their financial goals with sincerity and integrity. He works with GME program administrators, individual physicians and their families to help doctors achieve financial security. Richard is a graduate of the University of Texas at Austin, with a Bachelor’s Degree in Economics. He studied in Paris at the Sorbonne. Richard supports numerous charitable organizations, is actively involved in Austin Recovery, and he participates in the Leukemia Lymphoma Society as a survivor of CML. Richard is married to Adrienne with two children, Raven and Coates.