Veterinary medicine can place significant physical and cognitive demands on practitioners. Veterinarians may lift and restrain animals, stand for extended periods, perform procedures requiring fine motor control, and make decisions in situations where an animal’s condition can change quickly.
Injuries and medical conditions affecting these abilities can interfere with a veterinarian’s ability to perform the duties of the profession. Individual disability insurance may provide income protection when a covered condition prevents a veterinarian from working as required under the terms of the applicable policy.
For veterinarians, a disability claim may involve more than establishing the existence of an injury or medical condition. The claim may also require evidence concerning the physical demands of veterinary work, the veterinarian’s specific occupational duties, and the definition of disability contained in the policy.
The circumstances can also differ depending on whether the veterinarian is a practice owner or an associate. The effect of a disability on personal income and the continued operation of a veterinary practice may create different considerations when a claim is evaluated.
Why do veterinarians file individual disability insurance claims?
Veterinarians may develop disabling conditions through acute injuries, cumulative physical strain, occupational exposure, or other medical conditions that affect their ability to practice.
Disabling conditions and limitations may involve:
- Injuries sustained while handling, restraining, or treating animals
- Musculoskeletal conditions involving the back, neck, shoulders, hands, or other areas
- Repetitive strain from performing procedures and other clinical tasks
- Injuries or illnesses associated with occupational or zoonotic exposure
- Chronic pain, fatigue, or other conditions that affect physical stamina
- Conditions affecting concentration, coordination, or fine motor control
Animal handling presents physical demands that can be difficult to replicate in other medical professions. A veterinarian may need to respond quickly to an animal’s unpredictable movement while examining, treating, restraining, or performing a procedure. Injuries affecting the hands, wrists, shoulders, back, or other parts of the body may therefore interfere with essential occupational duties.
The cumulative demands of veterinary work can also contribute to disabling conditions over time. Repeated lifting, bending, standing, restraint, and other clinical activities may place ongoing stress on the body, even when there is no single injury that causes a veterinarian to stop working.
A disability claim generally focuses on how the condition affects the veterinarian’s ability to perform work under the applicable policy. A diagnosis alone does not establish that benefits are payable.
How does disability affect a practice owner differently from an associate veterinarian?
The financial and professional consequences of a disability may differ depending on the veterinarian’s role.
An associate veterinarian’s individual disability insurance claim may primarily concern the loss of personal income if a medical condition prevents the veterinarian from continuing to perform covered occupational duties. The applicable policy may provide benefits according to its specific definition of disability and other contractual requirements.
A practice owner may face the same personal income concerns while also dealing with questions about the continued operation of the practice. The owner may have responsibilities beyond treating animals, including management, staffing, financial oversight, and other administrative functions.
Those responsibilities can become relevant when an insurer evaluates the insured’s occupation. The policy may define disability based on the insured’s occupation or contain other provisions that affect how occupational duties are considered.
The distinction between ownership and employment does not by itself determine whether a claim is payable. The individual policy, the veterinarian’s actual occupational duties, and the evidence concerning the medical condition remain important.
A practice owner may also face consequences extending beyond the loss of personal income. Depending on the circumstances, an inability to perform clinical duties may affect staffing, patient care, management responsibilities, and the continued operation of the practice.
These issues can make it important to distinguish the veterinarian’s personal disability insurance claim from broader questions concerning business continuity. An individual disability insurance policy addresses the rights and obligations established by that policy, not necessarily every financial consequence associated with a practice owner’s disability.
How do individual disability insurance policies apply to veterinarians?
Individual disability insurance policies are contracts, and the terms of the specific policy determine how a claim is evaluated.
One important provision may be the definition of disability. Some policies contain an “own occupation” definition that focuses, depending on the language used, on whether the insured can perform the material and substantial duties of their own occupation.
For a veterinarian, those duties may include examining and diagnosing animals, performing procedures, administering medications, handling and restraining animals, using medical equipment, communicating with owners, and making clinical decisions.
The physical demands may vary depending on the veterinarian’s practice. A small-animal veterinarian may have different occupational requirements from an equine veterinarian, large-animal veterinarian, emergency veterinarian, or veterinarian working in another specialized setting.
An “own occupation” provision should therefore be considered within the context of the actual policy and the veterinarian’s occupation. The title “veterinarian” alone may not describe all of the physical and professional requirements relevant to a particular claim.
The policy may also contain other provisions affecting the claim, including requirements concerning proof of disability, elimination periods, benefit periods, and other contractual conditions. The applicable terms depend on the individual policy.
Why are disability insurance claims for veterinarians denied?
Disability insurance claims involving physically demanding occupations may face disputes concerning the extent of the claimant’s limitations and whether those limitations prevent the performance of occupational duties.
Insurers may question whether a physical condition actually prevents a veterinarian from performing clinical work. An insurer may argue, for example, that a veterinarian who cannot perform certain physically demanding tasks could continue working in a more limited or modified capacity.
The analysis may become more complicated when the veterinarian has administrative or management responsibilities in addition to clinical duties. An insurer may focus on the portions of the occupation that can still be performed while giving less weight to the physical or clinical functions that the veterinarian can no longer perform.
The available medical evidence can also affect the evaluation. Records that establish a diagnosis but do not explain the resulting functional limitations may leave important questions unanswered.
Other issues may include inconsistencies in the claim record, disputes concerning symptom severity or duration, insufficient information concerning occupational duties, or disagreements about whether the documented limitations are consistent with the applicable disability standard.
A denial does not necessarily resolve those issues. The insurer’s reasoning should be evaluated against the specific policy language and the evidence contained in the claim record.
What happens after a veterinarian’s disability insurance claim is denied?
The next steps following a denial depend on the type of policy, the policy’s requirements, and the circumstances of the claim.
A denial letter generally explains the insurer’s position and may identify the policy provisions and evidence relied upon in reaching the decision. Those reasons identify the issues that may need to be addressed in an appeal.
An appeal may require additional evidence rather than simply restating the original claim. Medical records may need to provide greater detail concerning functional limitations, while occupational evidence may help establish the physical and clinical demands of veterinary work.
For example, evidence concerning an inability to safely lift or restrain animals may be relevant when those activities are material to the veterinarian’s occupation. Similarly, documentation concerning limitations involving hand function, standing, bending, or fine motor control may be important when those abilities are necessary to perform clinical procedures.
Vocational evidence may also be relevant when there is a dispute concerning the duties of the veterinarian’s occupation or whether the insured can perform other work.
Deadlines are another important consideration. The applicable deadline for an appeal may be established by the policy or other governing requirements. Failing to comply with an applicable deadline can affect the ability to pursue further review.
An appeal should therefore be evaluated in light of both the insurer’s reasons for denial and the evidence available to address those reasons.
When should a veterinarian consider an individual disability insurance attorney?
Whether to handle a disability insurance appeal without legal representation depends on the circumstances of the claim. A relatively straightforward claim may involve limited disagreement about the medical evidence or occupational requirements. Other claims can involve disputes over the definition of disability, the physical demands of veterinary work, or whether a veterinarian can continue performing certain duties.
An individual disability insurance attorney can review the policy, the insurer’s reasons for denying the claim, and the evidence supporting the disability. For a veterinarian, that review may include examining the physical requirements of animal handling, procedures, standing, lifting, restraint, and other clinical responsibilities in relation to the documented medical limitations.
Legal counsel may be particularly relevant when an insurer argues that a veterinarian can continue working in a modified capacity or perform other veterinary-related duties. A disability insurance lawyer can evaluate whether that position is consistent with the policy and whether the claim record adequately addresses the veterinarian’s actual occupation.
Additional medical, occupational, or vocational evidence may also be relevant to the appeal. Counsel can help develop the claim record and prepare an appeal within the applicable deadline. If the coverage is governed by ERISA, counsel can also evaluate the procedural requirements that may apply to an ERISA disability appeal.
The decision to seek legal guidance ultimately depends on the individual policy, the reasons for the denial, and the circumstances of the claim.
Learn More About OBD’s Individual Disability Insurance Practice.