Addiction, Disability Insurance and Your Professional License
This article originally published in PHP Update, Spring 2019 from PA Physicians’ Health Program.
We all know that addiction takes a heavy toll on the individual suffering from a substance use disorder, their family, friends, colleagues and coworkers. Should this addiction involve diversion, fraudulent prescribing, DUI or medical mishap, the consequences can also have a serious impact on a professional license, including revocation, suspension, probation, and the payment of fines and penalties. Additional consequences may include the loss of DEA registration, exclusion from the Medical Assistance Program, being prohibited from participation in health insurance panels and a report to the National Practitioner Data Bank (NPD). Disability insurance can help to alleviate some of the financial difficulties caused by addiction, such as loss of employment and costs of treatment. But what happens to these benefits when a physician whose license is restricted in some manner attempts to return to the practice of medicine?
“Although there can be many obstacles in returning to the practice of medicine after treatment for addiction, they are not insurmountable.”
A Mayo Clinic 2009 editorial reviewed data from numerous Physicians’ Health Programs (PHP) and noted that many chemically dependent physicians, including anesthesiologists, returned to clinical practice. The difficult challenge facing physicians receiving disability benefits and attempting a return to practice is convincing the State Board of Medicine or Osteopathic Medicine they are safe to practice while at the same time certifying to the disability insurer they are disabled under the policy. Although this may seem to be a contradiction, it is possible to effectively do both.
In devising a strategy to return to work while maintaining disability benefits, a physician must be familiar with the language contained in the policy. An “own occupation” policy in most circumstances will permit a physician to continue to receive disability benefits even if he or she returns to full-time work in a medical specialty other than the one practiced prior to disability. Under an “own occupation” policy a physician may also, in some circumstances, continue to collect disability benefits when they return to work performing non-material aspects of their prior occupation (for example, an orthopedic surgeon who returns to work performing office examinations only and no longer performs surgery).
Often the physician’s treatment providers may advocate for a gradual return to work: part-time, no-call, etc. In such cases, it may be possible to receive partial or residual disability benefits under the disability policy. These types of benefits provide a physician with benefits that directly correlate to a loss of pre-disability income. Typically, a physician will have to suffer at least a 20-percent loss of pre-disability income to be eligible for partial or residual disability benefits.
The strategy presented to the State Boards of Medicine or Osteopathic Medicine and the disability insurance company is dependent upon the policy language, the opinions of treatment providers, and the physician’s health and ability to practice safely. To be successful, the strategy must be well thought out in advance of any petition for re-instatement in order to prevent the termination of disability benefits during the three- to six-month period that the Boards may take to reinstate a physician’s license.
Although there can be many obstacles in returning to the practice of medicine after treatment for addiction, they are not insurmountable. Understanding disability insurance policy and pre- planning a return to work will make the transition back to work much more seamless while continuing to ensure financial stability.
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