Doctors and Surgeons: How to Prove a Long Term Disability Claim

If you’re a physician or surgeon facing a medical condition that limits your ability to work, navigating the long term disability ("LTD") process can be unexpectedly complex and frustrating. Your profession is not only physically demanding, but also mentally and emotionally intense—yet insurers often reduce your role to a few physical tasks or outdated job descriptions.

Below we'll answer the most common questions doctors and surgeons have about qualifying for and securing LTD benefits.

Why are long term disability claims especially challenging for doctors and surgeons?

Filing for long term disability as a physician or surgeon comes with unique hurdles. Your work isn’t just physically demanding—it’s also intellectually intense and emotionally taxing. Insurers often don’t appreciate just how multifaceted your role is. Whether you’re performing surgery, diagnosing complex cases, or managing emergencies, your job requires a combination of stamina, sharp cognitive abilities, and emotional resilience.

Unfortunately, disability insurance companies may overlook these realities. They tend to simplify your occupation down to a few physical tasks, ignoring the full scope of what your role truly demands. This can lead to unfair claim denials, even when you’re clearly unable to continue practicing safely or effectively.

If you’re a doctor or surgeon considering a long term disability claim, it’s important to be aware that your claim may be scrutinized more than most. That’s why providing detailed evidence of how your condition impacts your specific job duties is critical.  

How do doctors qualify for long term disability benefits?

Qualifying for long term disability (“LTD”) benefits starts with meeting the definition of “disability” outlined in your specific insurance policy. But for doctors and surgeons, that definition can make or break your claim.

Most policies fall into one of the following categories:

• • Own Occupation: You qualify as disabled if you’re unable to perform the material duties of your own occupation—which, for a physician or surgeon, means your specific medical specialty. This is the most favorable definition, especially for specialists like orthopedic surgeons, anesthesiologists, or cardiologists.
  • Modified Own Occupation: You’re considered disabled if you can’t perform your own occupation and are not working in another occupation. Some policies pay benefits even if you choose to work in a different, lower-demand field (e.g., teaching, consulting), while others may reduce or deny benefits if you do.
  • Any Occupation: This more restrictive definition requires that you be unable to perform any occupation for which you’re reasonably suited by education, training, or experience. Insurers may argue that you can still work in a less demanding medical or non-clinical role.

To successfully qualify for benefits, your insurer will require that you:

• • Clearly define your own occupation—not just as “physician,” but in terms of your specialty and specific job duties.
  • Demonstrate how your condition prevents you from safely and effectively performing those duties, including cognitive, physical, and emotional components.
  • Include strong medical evidence from your treating providers supporting your restrictions and limitations.

For surgeons and specialists, the “own occupation” language can provide important protection. However, disability insurers may still try to interpret it narrowly. That’s why it’s crucial to submit thorough documentation that accurately reflects what your job truly entails. 

What’s the difference between a group ERISA policy and a private disability policy? 

As a physician or surgeon, the type of long term disability (“LTD”) policy you have can significantly impact your claim experience. Most LTD policies fall into one of two categories: group (ERISA) policies or private (individual) policies. Understanding the difference can help you anticipate what to expect—and avoid costly missteps.

Group policies are typically provided through your employer or hospital system and are governed by a federal law known as ERISA (the Employee Retirement Income Security Act). These policies often come with:

• • Narrow definitions of disability
  • Limited benefits for mental health conditions
  • Shorter timeframes for filing appeals
  • A requirement to go through your insurer’s internal appeal process before filing a lawsuit

Private or individual disability policies, on the other hand, are policies you purchase yourself—often early in your medical career or through a professional association. These policies are not governed by ERISA and generally offer:

• • More robust “own occupation” definitions tailored to your specific specialty
  • Greater flexibility in working in another field while still receiving benefits
  • Stronger legal protections, including the right to a jury trial and broader evidence review in court
  • Fewer procedural restrictions during the appeal process

Private policies are often more expensive, but they offer a level of protection that can be especially valuable to specialists who depend on fine motor skills, cognitive acuity, or other highly specific abilities.

If you’re unsure what type of policy you have, reviewing your benefits booklet and speaking with an experienced long term disability attorney can help clarify your options and inform your strategy moving forward.  

What does the DOT say about the duties of a physician or surgeon?

The Dictionary of Occupational Titles (“DOT”) assigns separate codes and job descriptions to different medical roles. While these entries may sound accurate on the surface, they fail to capture the full range of duties and demands doctors and surgeons face in real practice.

For example:

• • Family Physician (Code: 070.101-026): The DOT says the role includes examining patients, recording medical history, ordering tests, analyzing results, diagnosing conditions, and prescribing treatment.
  • Surgeon (Code: 070.101-094): According to the DOT, a surgeon performs operations, reviews reports, ensures surgical setup safety, and evaluates risks before procedures.

While these descriptions cover basic tasks, they overlook:

• • The intensity and duration of surgeries or patient care.
  • The precision and stamina required during long operations.
  • The constant need for real-time judgment and critical decision-making.
  • The stress of being responsible for life-and-death outcomes.

These omissions can hurt your disability claim if insurers use the DOT alone to define your job. That’s why when filing a long term disability claim, it’s important to provide a more accurate and personalized account of your actual work functions and responsibilities.

Are there more accurate resources for defining physician job duties?

Yes, another resource used by insurers (and sometimes courts) is the Occupational Information Network, or O*NET. Unlike the DOT, O*NET offers more detailed and up-to-date descriptions of professional roles, including those in the medical field.

O*NET is particularly helpful because it:

• • Breaks down job functions into physical, cognitive, and interpersonal demands.
  • Is continuously updated with input from professionals in each field.
  • Provides role-specific information depending on medical specialty (e.g., cardiologist, orthopedic surgeon, emergency physician).

For physicians and surgeons, O*NET outlines key requirements such as:

• • Cognitive skills (critical thinking, complex problem-solving, judgment and decision-making)
  • Interpersonal skills (active listening and communication with patients and medical teams)
  • Physical and sensory demands (manual dexterity, near vision, arm-hand steadiness)

Even though O*NET is more detailed than the DOT, it still may not capture the full scope of your unique medical practice. That’s why your own detailed explanation—backed by medical documentation—is essential to a strong long term disability claim.

What specific physical abilities might be required in different medical specialties?

As a physician or surgeon, your physical abilities are often specialized and essential to safely perform your duties. Yet, long term disability insurers tend to reduce your role to basic actions like standing, walking, or lifting, ignoring the more nuanced physical demands that vary by specialty.

For example, a heart surgeon’s job isn’t just about being able to stand during surgery. It also requires:

• • Excellent hand-eye coordination
  • Manual and finger dexterity
  • Steady hands for precision procedures
  • Strong near vision for detailed surgical work
  • The ability to bend over a patient for extended periods
  • Physical endurance during long surgeries

Other specialties have different physical challenges:

• • Emergency medicine physicians must be able to react quickly, move rapidly between patients, and physically intervene in trauma scenarios.
  • Orthopedic surgeons may handle heavy limbs or operate specialized tools requiring grip strength and upper body endurance.
  • Ophthalmologists rely heavily on fine motor skills and visual acuity, often for microscopic procedures.

These are not minor requirements. If your medical condition compromises any of these abilities, it may be impossible to safely or effectively continue in your role—even if you’re still able to walk or lift small objects.

How are cognitive and emotional demands evaluated in a long term disability claim?

Cognitive and emotional capabilities are just as essential to your role as a physician or surgeon as physical ones—but they’re often underestimated by insurance companies. While the DOT barely addresses mental demands, O*NET does include them, yet even that may not fully reflect the complexity of your work.

Your job likely requires:

• Sharp cognitive skills, including critical thinking and clinical judgment, fast, accurate decision-making in high-pressure situations, multitasking under time constraints, and rapid interpretation of test results and symptoms;
• Emotional resilience, such as managing stressful, high-stakes environments, supporting patients and families during traumatic experiences, coping with the emotional weight of life-or-death outcomes, and staying composed during emergencies or code situations

If a medical condition affects your memory, processing speed, concentration, or emotional stability, your ability to safely practice medicine may be compromised—even if you’re physically capable of standing in an exam room.

Because these aspects of your work are hard to quantify, it’s crucial to clearly document how your cognitive or emotional limitations prevent you from practicing safely. Supporting letters from colleagues, neuropsychological evaluations, or treating physician opinions can be key.

Can I work in a different role and still receive disability benefits?

Yes, in many cases, physicians and surgeons can still receive long term disability benefits even if they transition to a different, lower-demand role. Whether this is allowed, and how it affects your benefits, depends largely on the specific language in your policy, particularly how it defines “disability.”

If your policy uses an “own occupation” definition of disability, you may be considered disabled if you’re unable to perform the substantial and material duties of your specific medical specialty, even if you’re working in a completely different occupation.

For example, if you’re a neurosurgeon who can no longer perform surgeries due to tremors or cognitive issues but you begin teaching medical students or consulting for a healthcare startup, your policy may still pay full benefits since you’re no longer practicing in your own occupation.

However, it’s critical to check for any modifiers in the policy language. Some policies include:

• • “Transitional own occupation” definitions, which may reduce your benefits if your income from the new role exceeds a certain threshold.
  • “Any occupation” definitions, which typically kick in after 24 months and require that you be unable to work in any gainful occupation for which you’re reasonably qualified.

In addition, many policies offer residual or partial disability benefits. These are designed for situations where you’re not totally disabled but have had to reduce your hours, responsibilities, or income due to your condition. With residual benefits, you may continue working part-time or in a limited capacity and still receive a portion of your disability benefit to offset lost income.

To qualify for residual benefits, you generally need to show:

• • A loss of income (typically a certain percentage below your pre-disability earnings)
  • A medical condition that limits your ability to perform all the duties of your prior role
  • That you’re working to the extent that you’re medically able

Understanding how your policy treats alternative work and partial disability is essential before making any career changes. Transitioning to a different role without reviewing your policy or consulting a long term disability attorney could unintentionally jeopardize your benefits.

What steps should doctors and surgeons take to strengthen their disability claim?

When you’re a physician or surgeon filing for long term disability, your insurance company will require more than just a diagnosis to approve your benefits. Your claim should paint a complete and convincing picture of how your condition prevents you from performing your specific medical duties. That means being proactive, strategic, and thorough from the very beginning.

One of the most effective ways to strengthen your claim is to document your occupation in detail. Generic job labels like “physician” or “surgeon” don’t reflect the reality of your daily responsibilities. Instead, you should clearly explain the procedures you perform, the physical stamina your role demands, the cognitive skills you rely on, and the emotional stressors you face. Tailor your description to your medical specialty and work environment, whether that involves complex surgeries, emergency on-call shifts, or intensive patient management.

Comprehensive medical documentation is essential. Your treating providers should offer more than brief progress notes—they should provide narratives that specifically explain how your condition affects your ability to carry out your medical duties. It’s important that these statements go beyond general limitations and directly connect your symptoms to the core functions of your job.

To add credibility and depth to your claim, you may also want to undergo additional assessments:

• • A Functional Capacity Evaluation ("FCE") can measure your physical abilities, endurance, and limitations in a clinical setting. This is especially useful if your condition involves musculoskeletal or neurological impairments.
  • A Neuropsychological Evaluation can be critical if your disability includes cognitive symptoms—such as difficulty with memory, concentration, or decision-making—that interfere with your ability to safely practice medicine.
  • A Vocational Assessment may help explain why your specific job duties are incompatible with your current limitations, even if you technically remain qualified for other work.

These evaluations can provide objective support for your claim and help counter your insurer’s efforts to downplay or misrepresent your condition. It’s also important to ensure consistency across all your claim forms, medical records, and physician statements. Any inconsistencies—however small—can be used by the insurance company to cast doubt on your credibility.

Finally, working with an experienced long term disability attorney can make a significant difference. A knowledgeable attorney will help you navigate the complexities of the claims process, avoid common pitfalls, and develop the kind of detailed occupational evidence that insurance companies often overlook or misinterpret.

How can a vocational assessment help support my long term disability claim as a doctor?

A vocational assessment can be a powerful tool in your long term disability claim, especially if you're a physician or surgeon whose role involves specialized skills that aren’t fully captured by generic job descriptions. This type of assessment provides an expert evaluation of your ability to perform your specific occupational duties in light of your medical condition.

Here’s how a vocational assessment can strengthen your claim:

• • Defines your “own occupation” more accurately: Vocational experts can describe your job in far more detail than your insurer’s reliance on the outdated Dictionary of Occupational Titles ("DOT") or general labels like “physician.” They will factor in your subspecialty, daily duties, work environment, schedule, and required physical and cognitive abilities.

  • Connects your limitations to your job demands: A vocational assessment analyzes how your symptoms—such as pain, fatigue, cognitive issues, or mobility impairments—directly impact your ability to perform your professional duties. This connection is key to proving disability under an “own occupation” standard.

  • Counters insurer assumptions: Insurers often argue that if you can still think clearly or move around, you can practice medicine in some form. A vocational assessment can rebut this by showing how even subtle impairments can prevent safe or effective practice in your field, especially when precision, stamina, and split-second judgment are required.

  • Supports residual or partial disability claims: If you're still working in a limited capacity or different role, a vocational expert can explain why your current duties no longer match your prior occupation—and how your reduced capacity justifies residual disability benefits.

  • Lends third-party credibility to your claim: A written report from an independent vocational expert carries weight because it is objective and often rooted in labor market analysis, occupational data, and functional testing. Insurers are more likely to take such documentation seriously, especially if they challenge your self-reported or physician-stated limitations.

For physicians with complex, high-responsibility roles, a vocational assessment can make the difference between a denied claim and a successful one. It fills the gap between your diagnosis and the real-world impact that condition has on your professional life.

How can an attorney help secure my long term disability benefits?

Working with an experienced long term disability attorney can make a critical difference in the success of your claim—especially if you’re a physician or surgeon whose work involves complex, highly specialized duties. Insurers often oversimplify or misunderstand medical roles, and they may deny valid claims without proper explanation. A skilled attorney understands how to effectively push back.

Here’s how an attorney can help strengthen and protect your claim:

• • Clarifying your occupational duties: Attorneys understand how to present your job as more than just a generic “doctor” or “surgeon.” They’ll work with you to document your true occupational demands—physical, cognitive, and emotional—using detailed descriptions, employer letters, and even expert evaluations if needed.
  • Coordinating supportive medical evidence: Many claims are denied not because the condition is invalid, but because the documentation isn’t strong enough. An attorney can work with your treating physicians to ensure their statements clearly connect your condition to your inability to perform your specific job duties.
  • Securing additional assessments: Attorneys can arrange for independent evaluations—like Functional Capacity Evaluations, neuropsychological testing, or vocational assessments—to provide objective, third-party support for your limitations. These reports can carry significant weight with insurers.
  • Managing deadlines and appeals: If your claim is denied, ERISA policies impose strict deadlines for filing appeals—and you typically only get one shot to avoid litigation. Your attorney will handle all deadlines, preserve your legal rights, and build the strongest possible appeal record to support litigation if necessary.
  • Protecting you from insurer tactics: Insurers may conduct surveillance, misrepresent policy terms, or pressure your doctors for misleading statements. An attorney can spot these tactics early and intervene to protect your interests.
  • Leveling the playing field: Disability insurance companies have extensive legal resources and experience challenging claims. With an attorney on your side, you’re no longer navigating the process alone—you have someone who knows how to fight back.

Hiring a long term disability attorney is not just about legal knowledge; it’s about strategy, communication, and ensuring your claim tells the full story of how your condition has changed your ability to practice medicine safely and effectively.

Conclusion

Physicians and surgeons have a lot to lose if their long term disability claims are denied.  The challenges that they face are unique, given the high-level and multifaceted work that these occupations demand. If you’re thinking about filing a long term disability claim as a physician or surgeon, you should preemptively consult with a long term disability attorney to obtain critical guidance.

Riemer Hess has been helping disabled professionals, including many physicians and surgeons, successfully receive their benefits for over 30 years.  Our disability lawyers will tackle your unique case with our proven strategy.  We know how to bypass an insurance company’s roadblocks and protect your financial future.  Call us today at (212) 297-0700, or click the button below to schedule a free consultation.