Doctor or Physician Disability Insurance Denials

Your career in medicine represents a lifetime of sacrifice, skill, and service. Whether you’re a PCP, hospitalist, surgeon, radiologist, or specialist in another high-stakes field, you’ve built a practice that depends on precision and peak performance. When an illness or injury interferes with your ability to safely perform your specialty, your disability insurance policy should provide financial protection.

Many doctors purchase high-limit, own-occupation disability insurance policies for exactly this reason. These policies are often high-limit disability insurance contracts, reflecting the significant income levels and specialized skill sets of medical professionals. But higher coverage amounts also attract greater scrutiny from insurers, who may seek to limit payouts through narrow policy interpretations or misleading investigations.

At Sandstone Law Group, we help physicians, surgeons and medical professionals nationwide fight back against wrongful denials—and hold insurers accountable when they act in bad faith.

At Sandstone Law Group, we represent doctors whose individual disability claims have been delayed, underpaid, or denied outright. We understand the value of your license, your livelihood, and your time. And we know exactly how insurers try to take it all away.ng-term disability benefits to help you get by.

Why Doctors Face Unique Challenges in Disability Claims

Physicians are not shift workers performing interchangeable duties. Yet many insurers overlook the nuanced judgment, precision, and professional standards that define the practice of medicine. A disability claim is not merely about whether you can work—it's about whether you can safely and effectively perform the core functions of your specialty in accordance with medical standards and patient expectations.

We have seen insurers claim:

• You are “not disabled” because you can do some administrative work, even if you can no longer operate, diagnose, or treat patients.
• Your neurological, stress-related, or pain-based condition is “subjective” or “self-reported,” and therefore excluded.
• Your loss of income doesn’t qualify as total disability, even after a dramatic drop in procedures, referrals, or patient load.

These are not good-faith misunderstandings. These are deliberate strategies used to avoid paying valid claims. These are especially common in individual disability insurance (IDI) denials, where doctors tend to carry high-dollar policies marketed as “own-occupation” protection.

“Own-Occupation” Disability Coverage

Most private IDI policies sold to doctors are marketed as own-occupation policies, meaning you are entitled to benefits if you can no longer perform the specific duties of your medical specialty, even if you could technically work in another capacity.

In reality, insurers often twist this definition. They may argue:

• Your specialty is not narrowly defined enough to qualify
• You are still “practicing” because you are consulting, teaching, or doing administrative work
• Your residual income disqualifies you from full benefits

We challenge these distortions. We work with medical experts, vocational analysts, and financial advisors to prove what your policy actually says and what your disability truly means for your practice.

Doctor Disabling Conditions

Being a physician requires mental endurance, physical control, and emotional resilience while functioning at an elite level, often under pressure. When illness or injury compromises even a small part of that ability, the consequences can be career-ending.

Below are some of the most common disabling conditions we see in doctor disability claims, along with how they interact with your profession:

Musculoskeletal and Orthopedic Conditions

Musculoskeletal and orthopedic conditions are among the most common causes of disability among physicians, impacting not only surgeons, but also internists, pediatricians, emergency physicians, OB-GYNs, and other frontline practitioners. Whether caused by years of repetitive strain, trauma, or degenerative disease, these conditions can severely impair a doctor’s ability to perform core clinical duties safely and effectively.

Common diagnoses include:

• Cervical and lumbar disc herniations or degenerative disc disease
• Radiculopathy and spinal stenosis
• Rotator cuff tears, impingement syndromes, and adhesive capsulitis
• Carpal tunnel syndrome, De Quervain’s tenosynovitis, and ulnar neuropathy
• Arthritis in the hands, wrists, knees, and hips (including osteoarthritis and rheumatoid arthritis)
• Chronic low back pain, myofascial pain syndrome, or sacroiliac dysfunction
• Joint instability or meniscal injuries in the knees
• Plantar fasciitis, Achilles tendon injuries, and foot/ankle disorders

These impairments can result in:

• Reduced fine motor control essential for surgical precision, injections, or catheter placements
• Inability to maintain prolonged standing, bending, or awkward postures often required during surgeries, rounds, or in-office procedures
• Decreased grip strength or range of motion, limiting the ability to perform tasks like suturing, intubation, or physical exams
• Chronic or breakthrough pain, which can interfere with concentration, patient interaction, and clinical decision-making
• Muscle fatigue or joint instability, raising the risk of accidents or procedural errors

Even partial impairment can render certain procedures unsafe, or impossible, making it unreasonable to continue practicing. In specialties where steady hands, physical endurance, or postural integrity are non-negotiable, continued practice may be not only unreasonable but medically and ethically untenable. Insurers may attempt to minimize these limitations, particularly if they focus on whether the physician can do certain tasks in theory.

Neurological and Cognitive Disorders

Neurological impairments, whether from trauma, autoimmune conditions, neurodegenerative disease, or infection can profoundly impact a physician’s ability to practice safely and effectively. While the physical effects may be more visible in some specialties, the cognitive burden of clinical decision-making is universal across the medical profession.

Common causes include:

• Multiple sclerosis (MS)
• Parkinson’s disease and other movement disorders
• Post-concussive syndrome and traumatic brain injury (TBI)
• Long COVID-related neurocognitive complications
• Epilepsy or seizure disorders
• Chronic migraine with aura or visual disturbances
• Autoimmune or inflammatory encephalopathies
• Brain tumors or post-surgical neurological effects
• Stroke or transient ischemic attack (TIA)
• Early-onset Alzheimer’s or other dementias

Functional impairments may include:

• Executive dysfunction, affecting planning, prioritization, and critical decision-making
• Reduced attention span, processing speed, or reaction time, which can impair diagnostic accuracy and procedural safety
• Memory lapses and sequencing errors, impacting medication reconciliation, clinical documentation, or complex patient management
• Coordination and hand-eye control deficits, which may render procedural tasks unsafe or impossible
• Cognitive fatigue, limiting endurance in high-volume or high-stakes environments
• Emotional dysregulation or apathy, which can disrupt team communication or bedside manner

Insurers often characterize these impairments as “mild,” “subjective,” or “non-disabling,” particularly when symptoms fluctuate or are not easily captured by standard diagnostic imaging. But in clinical practice, even a momentary lapse in attention, delayed response, or subtle cognitive slowing can have serious consequences for patient safety. At Sandstone Law Group, we fight to ensure they understand what those impairments really mean in your specific specialty.

Mental Health, Burnout, and PTSD

Psychological health is increasingly recognized as a legitimate and serious basis for disability. The emotional burden of practicing medicine, especially in high-stakes, trauma-exposed, or understaffed settings, can lead to psychological conditions that compromise safety, clinical judgment, and ethical care delivery.

Common impairments include:

• Post-traumatic stress disorder (PTSD) due to repeated exposure to traumatic events (e.g., emergency medicine, ICU, battlefield or disaster response)
• Major depressive disorder, often compounded by guilt, perfectionism, or chronic emotional exhaustion
• Generalized anxiety disorder, panic disorder, or obsessive-compulsive features that impair focus, decision-making, or patient interactions
• Burnout, now recognized by the WHO as an occupational syndrome, which can lead to cognitive weariness, depersonalization, and reduced efficacy
• Sleep disorders and secondary physical conditions (e.g., hypertension, migraines, immune dysfunction) stemming from chronic psychological strain.

These conditions can manifest in:

• Emotional blunting or overreactivity, impairing bedside manner or team communication
• Cognitive fatigue, poor concentration, and indecision under pressure
• Avoidance behaviors, such as calling out of shifts, avoiding high-acuity patients, or withdrawing from patient-facing roles
• Impaired clinical stamina, resulting in unsafe care over long shifts or repeated cases
• Loss of empathy or heightened irritability, which may violate professionalism standards and erode trust with colleagues and patients

Despite this, insurers often label these claims as “self-reported” and reject them. We challenge those rejections and ensure your lived experience is backed by clinical evidence and policy interpretation. We ensure that your psychological disability is evaluated in the full context of your specialty, scope of practice, and the high personal standards physicians are expected to uphold.

Long COVID and Post-Viral Syndromes

Many physicians were on the front lines during the COVID-19 pandemic and are now living with the consequences. Long COVID and similar post-viral syndromes can cause:

• Debilitating fatigue
• Brain fog or cognitive slowing
• Tachycardia and breathing impairments
• Difficulty performing even basic physical or mental tasks

Medication Side Effects and Treatment Impairments

Even when you are actively treating a separate health issue, the treatment itself can be disabling. Medications for chronic pain, autoimmune disorders, or mental health conditions can cause:

• Drowsiness
• Cognitive dulling
• Delayed reflexes or hand tremors.

In any other profession, this might not lead to a disability claim. But in medicine, your ability to perform with clarity, speed, and confidence is non-negotiable. We ensure that the distinction is clear in your case file.

Which Insurers Deny Physician Disability Claims Most Frequently?

Not all insurance companies are the same when it comes to physician disability claims. Some aggressively market high-limit, own-occupation policies to doctors, then turn around and scrutinize every word of your claim when you file. Here are several carriers our firm frequently sees involved in disputed or denied physician claims and some issues we’ve encountered:

Insurer	Common Issues
Unum	IMEs with generalists; may deny based on “subjective” pain or fatigue symptoms
Guardian/Berkshire	Narrow interpretation of specialty definitions; complex residual benefit rules
Principal	Disputes over residual vs. total disability; frequent financial documentation demands
MassMutual	May cause delays and do vague denials (common in mental health and neurological claims)
The Standard	High surveillance use; reliance on in-house doctors for denial support
MetLife	May deny based on vague exclusions; multiple rounds of paperwork requests

Knowing the patterns associated with each insurer helps us build targeted, effective legal strategies from day one. Our experience across these carriers gives us insight into how to push back and win.

Tactics Insurers Use to Deny Doctor Claims

Whether your policy is with MetLife, Unum, John Hancock, or another major insurer, we know the patterns. They include:

1. Questionable Independent Medical Exams (IMEs)

Insurers frequently send claimants to "independent" medical exams, but many of these physicians are not specialists in your condition and often work routinely with insurers. Their findings can be biased, incomplete, or dismissive, despite extensive documentation from your treating providers.

2. Repetitive Requests for Information

Insurance companies may continually ask for documents you have already submitted, pay stubs, physician letters, and treatment notes, causing confusion and delay. This paperwork fatigue can lead claimants to give up or miss critical deadlines.

3. Delayed Decisions Beyond Legal Time Limits

Under federal ERISA rules and state law, insurers must follow strict timelines for claim decisions. Insurance companies can delay decisions, creating stress and financial strain while violating your legal rights.

4. Ignoring Favorable Evidence

Insurance companies can isolate unfavorable portions of your medical records while disregarding strong support from your doctors, vocational experts, or specialists. When insurers control the narrative, fair outcomes disappear.

5. Lowball Settlement Offers

Rather than honor your full benefits, insurers may attempt to settle your claim for a fraction of its value, especially when you are financially vulnerable. These offers are rarely in your best interest.

Should You Appeal Your Physician Disability Denial?

If your IDI claim has been denied, your instinct may be to file an internal appeal. Insurers often encourage this and may even imply it is required.

There is no federal law that requires you to appeal an IDI denial before filing a lawsuit. That rule only applies to employer-sponsored LTD policies governed by ERISA. If you purchased your disability policy individually, as most physicians do, you are not obligated to go through the insurer’s appeal process before suing.

That said, an appeal can, in certain instances, be a powerful strategic tool if it is done right. Filing a well-constructed appeal can:

• Strengthen your future litigation by showing you acted in good faith
• Preserve credibility with the judge or jury, especially if the insurer wrongly claims you didn’t “give them a chance.”
• Create a written record of your objections, supported by expert reports, medical documentation, and vocational analysis
• Expose flaws in the insurer’s original decision that can be used to your advantage in court
• Open the door to negotiation before litigation is necessary

However, not all appeals are equal. A poorly written or incomplete appeal can actually hurt your case by locking in a weak version of the facts or omitting key evidence that may be difficult to introduce later.

Deciding to appeal or sue, or a combination of both, depends on:

• The strength of the denial and the reasoning the insurer provided
• The specific language of your policy, including appeal clauses or limitations
• Whether the denial contains procedural errors, misstatements, or bad faith tactics
• Your immediate financial and professional needs.

We do not give one-size-fits-all answers, because you are not a one-size-fits-all client. Instead, we will assess your case and determine the most effective path to compensation based on your goals and the law

Why You Should Never Appeal Without Legal Counsel

Disability insurers use appeal submissions to reinforce their original denial, not to fairly reconsider your claim. That is why it is essential to work with an attorney who:

• Knows how to structure the appeal for maximum legal leverage
• Anticipates how the insurer will attempt to minimize or reinterpret your condition
• Builds a record that preserves your ability to seek bad faith damages, emotional distress compensation, and punitive damages if the claim proceeds to court
• Understands how your medical specialty intersects with policy language like “own-occupation,” “partial disability,” or “residual benefit.”

At Sandstone Law Group, we carefully evaluate whether an appeal will help or hurt your position. If we recommend appealing, we take control of the process, drafting persuasive legal arguments, coordinating expert support, and creating a strategic record that keeps the pressure on the insurer.

Why Sandstone Law Group?

You deserve a law firm that understands the value of your career, the weight of your responsibilities, and the legal leverage it takes to make insurers deliver on their promises.

At Sandstone Law Group…

• We Understand Physicians—Because We’ve Walked This Path with Them: At Sandstone Law Group, we understand the unique physical and cognitive demands of being a phyisican—and how even subtle impairments can threaten your ability to practice safely. Whether your policy is with Guardian, Berkshire, Principal, or another major carrier, we know how to align real-world clinical duties with the language of your disability contract.
• We Listen First: From your time speaking with our attorneys, Kyle and Erin, we take the time to understand your daily responsibilities as a physician and your policy. You will not be rushed or handed a generic plan. We know your case is personal, and we approach it with the same care and precision you have given your patients.
• We Know the Insurer’s Playbook: We have gone head-to-head with nearly every major disability insurer in the country, including MetLife, Guardian, Unum, The Standard, and MassMutual. We know their tactics and we know how to dismantle them.
• We Are Prepared for Litigation: Unlike firms that solely concentrate on ERISA group plans, we focus heavily on IDI litigation. We know how to use bad faith laws to pursue punitive damages, emotional distress compensation, and full discovery, because private policies give us room to fight hard.
•  We Win for Medical Professionals Like You: Our firm has recovered millions in benefits and legal damages for medical professionals. Whether your policy promises “own-occupation” protection or includes layered coverage for partial or residual disability, we hold insurers accountable to the letter of the contract.
• We Treat Clients Like Partners: You are a high-level professional. We treat you like one. That means proactive communication, transparent strategy, and a legal relationship built on mutual respect. When you hire us, you are gaining a dedicated team.

Has Your Disability Claim Been Denied?

If you are a doctor and your private disability insurer is stalling, denying, or underpaying your claim, you do not have to face them alone.

You may still go to conferences. You may still have a medical license. But if you can no longer safely perform the core duties of your medical specialty, you are disabled under most IDI policies.

We fight to make sure the insurer understands what your job actually requires, and why your claim is valid, even if you're functional in daily life or non-clinical tasks.

Contact Sandstone Law Group at (602) 615-0050 to schedule a confidential consultation.

Frequently Asked Questions