Since the COVID-19 pandemic began, an unprecedented number of physicians are reporting mental health conditions ranging from anxiety and depression to post-traumatic stress disorder. In a , researchers from the American Medical Association and Hennepin Healthcare surveyed 21,000 U.S. healthcare workers, nearly 3,000 of whom were physicians. Almost a third (29.9%) of doctors reported experiencing high stress. Nearly half (47.7%) reported symptoms of burnout; more than a third (37.3%) said they felt overloaded with work.
As a doctor, you鈥檙e used to seeing your patients apply for disability benefits, but the process can seem entirely foreign when it鈥檚 your own claim. Is burnout a covered disability? Where do you start when you need to file a long term disability claim?
It鈥檚 a complicated process. Here鈥檚 what you need to know.
First, it鈥檚 significant to note that 鈥渂urnout syndrome鈥� has only been recently recognized as a legitimate medical condition by the World Health Organization. Meanwhile, the Diagnostic and Statistical Manual of Mental Disorders (more commonly known as the 鈥淒SM鈥�5鈥�) does not recognize 鈥渂urnout鈥� as an official diagnosis at all. Medical providers in the U.S. generally rely on the DSM-5 for diagnostic purposes. Insurance companies also refer to the DSM-5 when scrutinizing disability claims.
If you file for long term disability claiming solely 鈥渂urnout,鈥� your insurance company will likely be skeptical. They often assume you are just stressed, unhappy with your employer, or looking for an easy exit from your job. Since burnout is not a medically recognized diagnosis by the DSM-5鈥檚 standards, it is easy for your insurance company to delegitimize your condition and argue you are not actually disabled.
This doesn鈥檛 mean you are not entitled to long term disability benefits. Consider that burnout can be more of a symptom than a diagnosis. Your feelings of burnout may be underlying another mental health diagnosis such as post-traumatic stress disorder (PTSD), clinical depression, or an anxiety disorder. This is especially true if your mental health suffered as a direct result of working through the pandemic. Both PTSD and anxiety disorders are mental health conditions recognized by insurance companies as potentially disabling diagnoses.
The outcome of your disability claim depends on your specific insurance policy, your medical evidence, and how you frame your response to the insurer鈥檚 questions.
Most physicians have long term disability coverage through a private insurer. Typically, these policies are either provided by your employer (a group policy) or purchased for yourself (an individual policy). Both types of policies generally cover mental health conditions.
Private insurers are usually required to pay disability benefits if the insured cannot perform the 鈥渟ubstantial and material duties鈥� of their job. So, if your burnout results in a mental health condition preventing you from practicing medicine safely, you should be able to collect long term disability benefits. Take into account, however, that insurers may limit the length of time for which you can collect disability benefits for mental health conditions. Many policies limit benefits for a mental health disability to 24 months.
Proving a mental health condition as a disability presents a number of challenges. In order to receive disability benefits, you must:
Insurers often fail to recognize the true psychological impact of a physician鈥檚 job. Your insurance company may assume that your 鈥渂urnout鈥� is just ordinary job-related stress instead of a true medical condition.
This is likely what鈥檚 happening if your insurance company starts asking questions about what you didn鈥檛 like about your job. By shifting the focus from your legitimate mental health symptoms to your overall dissatisfaction with work, they鈥檙e preparing to deny your claim based on the argument that you just want to leave your practice.
The key to success is to avoid making any missteps throughout the process of filing your long term disability claim for burnout.
There are no guarantees with any long term disability claim, but there are a series of steps physicians can take to strengthen their burnout claim.
Most long term disability insurance policies limit the amount of time benefits are paid out for a mental health condition compared to a physical illness. Typically, policies limit benefits to 24 months, but it varies by the policy. You should be aware of this before you file.
It鈥檚 important to review the terms of your policy first, since they will dictate whether and how you proceed with your treatment and claim.
Insurers tend to write dense, convoluted language that can be used to limit coverage of mental health disability claims. Reviewing your policy with an experienced long term disability lawyer can help you interpret the contractual language and determine whether you have a viable claim.
When vetting providers, make sure you find someone you鈥檙e comfortable with. This is likely to be a continuing relationship. Your insurer will require you to receive ongoing treatment to qualify for long term disability benefits.
Make sure to report all symptoms to your treating providers. Their notes will help substantiate your disability claim to your insurer. Consider asking your doctor to provide your insurer a letter in support of your burnout-related disability as well. This can go a long way in proving your burnout as a legitimate disability to your insurer.
Most long term disability insurance policies will determine your material duties based on your responsibilities immediately before the date of your disability. So, if you find yourself gradually reducing your hours, accepting fewer responsibilities, or taking a leave of absence to cope with your burnout, you may lessen your compensable duties and jeopardize your ability to collect full benefits.
Some policies also require you to meet a certain threshold of weekly hours鈥攗sually at least 20 hours per week. If you fall short of that threshold鈥攅ven because you鈥檙e struggling with mental health issues due to burnout鈥攖he policy may not cover your claim.
If you must call your insurer to request a claim form, be prepared to discuss your claim with the representative immediately. It helps if you鈥檝e already spoken with an experienced disability lawyer so that you鈥檒l know what your policy requires and how you should answer any questions.
Your insurer also may ask you to sign release forms so that they can speak with your healthcare providers to learn more about your condition and your symptoms. They also may investigate further by asking for records of your medical treatment.
Your insurance company may want to meet with you face to face for an interview. They even may go so far as to hire a private investigator to conduct surveillance of you both in person and online. Your insurer will use these tactics to scrutinize 鈥� or possibly invent 鈥� any discrepancies in your claim.
In cases like these, it鈥檚 important to have legal representation that can step in when an investigation becomes too aggressive.
If you鈥檙e a healthcare provider suffering from pandemic-related burnout, you may be able to collect long term disability benefits. But the claims process can be long and complex. If your claim isn鈥檛 precisely correct, you may face a denial and a lengthy, expensive appeals process.
Don鈥檛 try to go it alone. Our experienced long term disability lawyers can guide you through the complicated, harrowing process of applying for long term disability or appealing a denied claim.
To arrange a consultation with one of our New York long term disability lawyers, click the button below or call us at (212) 297-0700.