The Vital Role of Disability Insurance for Physicians in Safeguarding Their Professional and Financial Futures

Stephanie Pearson, M.D., FACOG, was a successful OB-GYN practicing in Philadelphia, Pennsylvania, until an injury during a difficult delivery a decade ago left her with a frozen shoulder, disability insurance that wouldn’t cover what she needed and an eventual end to her career treating patients. Pearson turned those challenges into a new career, becoming a disability insurance broker and advocate and devoting her efforts to educating physicians to avoid what happened to her.

She is now CEO of PearsonRavitz, a disability insurance broker for medical professionals. The company’s goal is to act as an advocate to untangle and simplify the byzantine world of insurance and help their clients find the best coverage for them.

Medical Economics sat down with Pearson to discuss her story and what physicians need to know about the disability insurance market. The following transcript was edited for length, style and clarity.

Would you be willing to share your story about the injury that prompted this significant change and the challenges you encountered during this transition?

Pearson: Unfortunately, I was kicked in the left shoulder during a difficult patient delivery. She was one of my favorite patients, and I had delivered previous children of hers. In this case, I ended up needing a couple of nurses to help me get her in position. The first kick came right into my brachial plexus. My arm went numb; I started to tear up. I thought I was doing myself a favor by turning my body. Then I was kicked a second time, across my shoulder, and I felt a pop. I put the baby on (the) mom’s belly and called one of my partners in to help finish the delivery. Long story short, I ended up with a torn labrum that didn’t heal right and I developed a frozen shoulder.

August 3 of this year marks 10 years that I’ve been away from clinical medicine. I still have remarkable range-of-motion deficits and nerve damage. And I learned the hard way about insurance. Our group benefits at our hospital didn’t cover work-related injuries. I was flatly denied and told I would have been better off had I fallen off my bike. I did have a private policy but found out — like many physicians in this situation — that I didn’t quite understand what I had and it wasn’t exactly the kind of policy I should have had. My worker’s compensation claim initially got denied; they said while an injury occurred that my frozen shoulder was my fault, because I continued to work after I was injured. So that took 14 months and three court appearances. I eventually settled because I really wasn’t in a good headspace.

What motivated you to become a passionate advocate and adviser for physicians’ insurance needs?

Pearson: One of the reasons that I became an adviser is because I felt like I had not been properly educated, and telling my story made it a little bit easier. So I started lecturing to area residency programs, sharing my story. Here are the mistakes I made; here’s what you need to know and what I wish I knew. People started asking for my help, so I felt like there was this huge need. I had the experience that could lend itself to better education and better advocacy, and I get to use my medical knowledge in a way that your traditional agent or broker can’t.

What do you see insurance companies refusing to cover because of lack of medical knowledge on the matter that should be covered?

Pearson: There are things that insurance companies will exclude or not cover based on risk. And there have been several times where I must remember that community medicine and insurance medicine don’t always line up. And with that in mind, I still want things to be fair, and I get that life’s not fair, but I try the best I can.

Historically, there have been certain illnesses, diagnoses and medications that have led the underwriters down a certain path. For example, if the medication Truvada, which is one of the PrEP (preexposure prophylaxis) medications, showed up on an application, there would be an automatic decrease in the benefit period or the length of time that the carrier would pay for any illness or injury. I found that to be tailored against certain populations and argued against that. Thankfully, all the carriers have now changed the way that they’re underwriting those cases, so that’s a huge feather in our cap.

Another example: When I started doing this, any woman who had a C-section for any reason automatically didn’t have future pregnancies covered. That made no sense. It made sense to me to not cover complications of future C-sections but not necessarily to encapsulate the entire pregnancy. It took some time to get that change. At one point, we had all the big carriers on board. Unfortunately, one carrier has swung back. But that just leads to the proper education and advocacy, so if I’m speaking to a woman who has had a C-section, I’m not going to recommend that carrier. There have been a few like this where we’ve really been able to affect change in the market.

Can you provide an overview of the traditional approach to disability insurance coverage for physicians and the typical roadblocks you face when obtaining coverage?

Pearson: Currently, there are five insurance companies that truly cater to the medical space, and you’re looking at having to go through both medical underwriting and financial underwriting. It’s a little different if you’re in training or out of training, but we want to gauge how to get the best coverage that we can for people. The carriers are admittedly looking at their risk mitigation, and they’re trying to figure out what they can get away without covering. So it’s a matter of going through an application process. There are no secrets from the carriers; they can get medical, pharmacy and driving records. All these things get considered, and then they come up with their offer. I always caution physicians that you want to be properly educated about what’s in the policy and what’s not in the policy.

There are several roadblocks that we run into time and time again. The first has to do with pregnancy. I tell every woman applicant that they must have disability insurance in place before trying to get pregnant. Carriers look for almost any reason not to cover future pregnancies. Conditions like gestational diabetes really hurt an applicant’s coverage. When it comes to life insurance for women, gestational diabetes can double to quadruple the cost.

Another roadblock is not keeping up with standard of care when it comes to preventive screening tests, including both not maintaining proper screening and not following up on screening issues. Weight and BMI (body mass index) can be an issue. No one likes talking about it, right? But when we’re talking about insurance, it’s one of the few things that affects cost.

Mental health is a huge issue across the board because carriers really don’t like covering mental health. It’s a big reason that physicians leave practice now.

Finally, you want to make sure that there’s a paper trail with medications. What I mean by that is it’s easy when you are a resident or attending physician to look at your fellow resident and say, “Hey, I can’t get to my doctor. Can you just fill this prescription for me?” So what ends up happening is the carriers see who’s writing the medications, but there are no records to back it up. They view it as bad behavior. So I really press on people to take the time to follow up with your own treating physicians.

How did this experience shape your outlook?

Pearson: It comes down to trying to change an industry that historically has been confusing and in which physicians have been easy prey. I want to see change and see physicians getting the same education in financial literacy that we get in body mechanics, biology and chemistry and really make this part of our educational process.