When a physician is seriously ill or injured, a particular definition really matters: their plan’s definition of disability. In the employee benefits industry, plans can use a very broad definition, called Own Occupation. This broad definition can mean that although a physician cannot perform their specialty, they can still perform as a physician in general, and can thus be denied disability status.
Wouldn’t it be better to consider a physician’s actual area of specialty? We think so. It seems right to consider what a physician has been doing when determining disability status, not what that physician might be able to do.
Sun Life Financial considers a physician’s specialty. Our policy contains an Own-Specialty/Sub-Specialty definition of disability. This definition states that we consider the specific duties that a specialist performs every day when determining whether or not that specialist is disabled.
At a minimum, we analyze the specific duties being performed by a physician over the 12 months prior to disability, and use these duties as part of the determination of a claimant’s material and substantial duties.
When a physician files a claim, they need to know that the claims examiners will understand the special nature of their claim. That’s why we created a dedicated Sun Life Physician Claims Unit. It handles only disability claims for physicians and their staff. These specialized, dedicated claims examiners understand the material duties of each specialty or sub-specialty, the various ways physicians are paid, and how medical practices are structured.
