Medical Resident: When Should I Get Disability Insurance

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newdoc
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Medical Resident: When Should I Get Disability Insurance

Post by newdoc »

Hello,

So, towards the end of med school, a lot of schools have financial advisers come in to educate the students. One of the things we've been advised to do is get disability insurance during residency. In doing so, we can fix our rates, which are usually some percentage of current income, at a price far below what we'll ultimately be earning and end up saving a ton of money in the long run.

I've already decided to take advantage of this but my question now is: When exactly should I start paying for disability insurance. It will be 5-6 years before I'm out of training and making a high income. Until then, I'll be making a relatively paltry resident salary. So does it make a difference whether I sign on right away or wait 1 year or 2 or 5? I've gone this long without the insurance and feel totally comfortable "gambling" for another year or so before actually signing up for it. Is there some added incentive to starting earlier as opposed to just waiting a few more years even if there will be only slight augmentations to my annual income and (hopefully) no significant changes to my general health?

Thanks
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bottomfisher
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Re: Medical Resident: When Should I Get Disability Insurance

Post by bottomfisher »

http://whitecoatinvestor.com/tag/disability-insurance/

This link has various discussions on different aspects of disability insurance for physicians. I'm not sure if they remark on your specific question; but its a good resource regardless. I'm 3 years out of residency and I've "gambled" going without disability insurance through residency and now 3 years out of residency. I'm sure many would not advise to take this approach though
Calm Man
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Re: Medical Resident: When Should I Get Disability Insurance

Post by Calm Man »

I agree with bottom fisher. I am not sure you can get all that much disability insurance anyway as a resident as it is usually 60% max of salary and the salary is so low (but don't despair, it is only temporary).
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Re: Medical Resident: When Should I Get Disability Insurance

Post by hicabob »

newdoc wrote:One of the things we've been advised to do is get disability insurance during residency. In doing so, we can fix our rates, which are usually some percentage of current income, at a price far below what we'll ultimately be earning and end up saving a ton of money in the long run.
Having worked for an actuary many decades ago while in uni I would expect that's not likely. Those fellows are quite good at probability and statistics to say the least.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by LadyGeek »

This thread is now in the Personal Finance (Not Investing) forum (insurance).
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dhodson
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Re: Medical Resident: When Should I Get Disability Insurance

Post by dhodson »

yep its not true that you save money by buying as a resident

you just guarantee coverage since its already in force period.

cost is always a percentage of amount protected.

if they are telling you otherwise then i would consider telling your dept not to let this person back.

be very careful since i suspect they will also tell you to purchase permanent life insurance like whole life and that is highly unlikely to be a product that you should purchase.

although one of the other posters mentioned taking the gamble, typicaly the best advice isnt to gamble and lock in coverage with the ability to purchase further protection as your income rises (this will cost more period).

i am a physician and id say purchase as soon as it isnt a super hardship. Id look for own occ coverage. I also second looking at whitecoatinvestor.com for information on this. once you read his posts then come back and ask some more questions.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by LadyGeek »

The wiki has background info: Disability insurance

It will expand on what dhodson means by "own occ" (own occupation) coverage.
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newdoc
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Re: Medical Resident: When Should I Get Disability Insurance

Post by newdoc »

I just read through the whitecoatinvestor.com articles. It sure is complicated, but my fundamental question is this:

Can I, as a 1st-year resident physician, continue to go without disability insurance under the assumption that my health will probably go unchanged in the near future? Or is this a silly gamble not worth the $1000 that I would save?

If I can go without it as a 1st year resident, what about as a 2nd, 3rd, 4th or 5th-year resident?

In other words, I of course plan to get disability at some point, but when exactly is the right time? Right out of med school, in the middle of residency, towards the end of residency or as a new attending physician?

Thanks
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Re: Medical Resident: When Should I Get Disability Insurance

Post by bayview »

Do you have student loans? Do you have a family? Do you have an alternative back-up career that would not require the physical endurance and mental sharpness of medicine?

During med school and residency, did you ever see anyone who had significant head injuries, spinal and other fractures; anything that would make it tough or impossible to carry out the physical and mental requirements of being a physician?

Get the disability insurance now. This isn't worth cheaping out on.

My daughter's residency program pays for her long-term disability, but she would have bought it if they didn't. Best wishes for your career! :beer
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Re: Medical Resident: When Should I Get Disability Insurance

Post by am »

University typically covers during training. Not sure it is worth insuring your low salary on your own. If you develop some condition now I do not think they will let you get an attending policy without paying a ton. I waited until I finished residency and than continued my university policy at a discount. I got a modified own occ which basically is the same as own occ except if I work outside of my specialty, my payment will be reduced.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by bottomfisher »

Can I, as a 1st-year resident physician, continue to go without disability insurance under the assumption that my health will probably go unchanged in the near future? Or is this a silly gamble not worth the $1000 that I would save?

If I can go without it as a 1st year resident, what about as a 2nd, 3rd, 4th or 5th-year resident?

In other words, I of course plan to get disability at some point, but when exactly is the right time? Right out of med school, in the middle of residency, towards the end of residency or as a new attending physician?
Your question really revolves around the actuarial science numbers (ie financial impact of risk and uncertainty) of disability insurance for residents and physicians. Whats the percentage chance I will need it and should I get it? Unfortunately, I cannot provide further insight into those numbers. I presume most cannot either; as these numbers are the difference between profit and loss for insurance providers. And whether you are willing to take the risk is a measure of risk tolerance and you are the best person to assess that risk.

A certain number of residents/physicians will utilize their benefits every year. I felt the risk was low for myself from a risk stratification standpoint - I have no chronic health issues, I exercise, I drive non-aggressively and with a seatbelt, I don't use drugs, etc. My wife earns a comfortable salary; which also was factored into my decision to go without insurance. But the most important consideration for me personally is this - I perform periodic Independent Medical Evaluations through our clinic. It is my experience that the insurance companies fight tooth and nail not to pay out on disability policies. In full disclosure - there may be a few biases involved, ie 1) I don't see the more clear cut cases because they are paid out and not sent for and IME 2) I have never seen a physician for an IME so these policies may be structured differently as well.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by semperlux »

I don't know if this is the best approach this, but this is what I did:

During residency when my income was relatively low, my hospital employer provided non occupation specific group disability insurance which was fine. I couldn't have afforded own occ disability with the pay at that time, and even if I could, it wouldn't have been much coverage at 60% of residency income.

However in my last 1/2 year of residency, AFTER I secured my first attending position, I asked for a letter from my future employer to indicate what my first year attending pay would be. I aplied for disability insurance while I was still a resident but using my attending income. I only had to pay about 2-3 months of disability insurance with my resident salary before I became an attending, but by doing that was able to secure the best rate I could as a resident.

Since then I have bought more disability insurance every time I have a significant jump in pay & it is true...the premiums are more expensive for every extra dollar of coverage as I get older. I don't regret buying my disability insurance in residency one bit.

Hope this helps or gives you some perspective / information.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by BruDude »

The earlier you buy DI, the cheaper it will be for life since the premiums are locked in at the age it is purchased. Future Increase Option exercises have premiums based on the year in which they are exercised. Even as an early resident, you can still get up to $4-5,000/mo in coverage regardless of your current income. All of the major DI carriers have a "Young Professionals" type of program for occupations that are expected to result in high income levels. Some companies offer a graded premium option where premiums are lower in the initial years of the policy and increase every year based on age. Those premiums can be "leveled out" on any policy anniversary, so a lot of residents choose the graded option to keep the premiums low while in residency and then change to a level premium when they start working and have a higher income.

If you wait to buy and have any health issues, they could potentially result in a limitation on the benefit period, restriction on optional riders, pre-existing condition exclusions, or denial. The best time to buy DI is when you are young and healthy.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by White Coat Investor »

Buy it now and buy as much of it as they will sell you. You'll need to buy more when you become an attending as well.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by stjoe56 »

My brother is institutionalized in a long term care facility. He has been there over 50 years. Due to changing mores, they no longer institutionalize children like him. So the facility has found a new market niche. It treats traumatic brain injury. It is now has a number of young accountants, lawyers, doctors, etc. who suffered injury.

So I say get as much long term disability insurance as you can afford. For tax reasons, pay it with after tax dollars.


SJ

P.S In the matter of full disclosure, I am now retired and collecting on a long term disability insurance policy.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by jambadoc »

Several things to consider are the fact that true own-occupation (specialty specific) disability insurance could be cheaper as a resident and your family situation. I second the recommendation for WCI's blog above. There's a lot of good information there.

I actually thought that this information was posted somewhere on WCI's (emergdoc's) blog, but I can't seem to find it looking through all the links listed under disability insurance provided above (whitecoatinvestor.com) Individual disability insurance rates different specialties as different level of risk. The less risky ones are less expensive. It tends to rates residents (of all specialties) in one of the less risky categories. So, if you're in one of the higher risk categories (surgery, OB, EM as I recall - although it varies from company to company) you may save money by getting it as a resident (not to mention, you will be younger and likely healthier which will also decrease the price.)

When I was an intern, I was single with no kids. If I suffered a devastating injury, I would have been okay with medicaid - not ideal, but my loans would have gone away, etc. I got married as a PGY -3 and we had our daughter as a PGY-4. People were now actually depending on my income, so I got what they would give me as a PGY-3 (3000/month I think). The first year of my fellowship, my income basically doubled, and I doubled my coverage to 6000/month. When I finish, I expect my income to double again and I'll double my coverage again. As mentioned, pay for it with after tax dollars. If you were to become disabled, this will make a huge difference.

Finally, (mods- if this is too much of an ad, please feel free to delete) I used a service at doctordisability.com. I didn't have a lot of time as a resident, and they basically shopped all the major own-occ companies in my state, gave me the 4-5 best quotes broken down into an easy to understand table that compared all the relevant features and prices, and helped with all the paperwork when I decided. They send me reminders when I can re-up my policy, and overall I found them extremely helpful and professional. I'm sure they make a commission, but the price you pay is the same you would pay if you do the legwork yourself (I checked with two of the companies personally.)
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Re: Medical Resident: When Should I Get Disability Insurance

Post by newdoc »

So, I think I'm going to wait just a couple of years to get the insurance. The coverage that I can afford right now is just not much more than what I could depend on my family for in the unfortunate event of sustaining a disability. And as a young, fit male in excellent health, I'm comfortable, for now, running on the bet that I won't become significantly disabled in the near future. I'll wait for just a few years. That way, I can get coverage on the much larger salary that I'll be expecting at that time, which would be far more than what I could depend on my family for, and I could do so while still taking advantage of the lower rates available to low-income residents.

Thoughts?
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Re: Medical Resident: When Should I Get Disability Insurance

Post by BruDude »

newdoc wrote:So, I think I'm going to wait just a couple of years to get the insurance. The coverage that I can afford right now is just not much more than what I could depend on my family for in the unfortunate event of sustaining a disability. And as a young, fit male in excellent health, I'm comfortable, for now, running on the bet that I won't become significantly disabled in the near future. I'll wait for just a few years. That way, I can get coverage on the much larger salary that I'll be expecting at that time, which would be far more than what I could depend on my family for, and I could do so while still taking advantage of the lower rates available to low-income residents.

Thoughts?
You could get a maxed out policy for around $100/month with the graded premium structure while in residency. There is a risk in waiting that you could have health problems between now and the time you decide to apply. Let's say you get into a car accident and have treatment for back pain - that would become a permanent exclusion and possible cause for being declined altogether. Let's say you are going through some rough times and start seeing a psychologist - now you could have a 5-year benefit limitation, mental health exclusion, and/or increased premiums. Let's say you are playing basketball at the gym and tear an ACL - now you have an exclusion for that knee. You get the idea.

One of the common problems that many physicians run into when they wait until getting out of residency to buy a policy is the group LTD that is offered by their employer, who pays 100% of the premium and does not allow the physician to opt out of coverage. This can severely limit the amount of individual disability insurance that you can get, and the group LTD benefits are not going to be anywhere near as good as what is covered on an individual disability policy.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by newdoc »

BruDude wrote:
newdoc wrote:So, I think I'm going to wait just a couple of years to get the insurance. The coverage that I can afford right now is just not much more than what I could depend on my family for in the unfortunate event of sustaining a disability. And as a young, fit male in excellent health, I'm comfortable, for now, running on the bet that I won't become significantly disabled in the near future. I'll wait for just a few years. That way, I can get coverage on the much larger salary that I'll be expecting at that time, which would be far more than what I could depend on my family for, and I could do so while still taking advantage of the lower rates available to low-income residents.

Thoughts?
You could get a maxed out policy for around $100/month with the graded premium structure while in residency. There is a risk in waiting that you could have health problems between now and the time you decide to apply. Let's say you get into a car accident and have treatment for back pain - that would become a permanent exclusion and possible cause for being declined altogether. Let's say you are going through some rough times and start seeing a psychologist - now you could have a 5-year benefit limitation, mental health exclusion, and/or increased premiums. Let's say you are playing basketball at the gym and tear an ACL - now you have an exclusion for that knee. You get the idea.

One of the common problems that many physicians run into when they wait until getting out of residency to buy a policy is the group LTD that is offered by their employer, who pays 100% of the premium and does not allow the physician to opt out of coverage. This can severely limit the amount of individual disability insurance that you can get, and the group LTD benefits are not going to be anywhere near as good as what is covered on an individual disability policy.
I see, but the thing most likely to happen to my health status at this point is: nothing. Even if I somehow did wind up claiming disability, perhaps for a broken bone or a bout of depression, I would most likely be out of work for a couple of months at best. In any of these circumstances, I'd be able to get assistance from my family. Now, the chance of me being more substantially disabled somehow is indeed there, but it is exceedingly small and I feel that I'm being taken advantage of when insurance sellers tell a young, extremely healthy male like me, "You could be out for life." They're basically using fear mongering to get what they already know is an almost guaranteed $1,000/yr in revenue. In actuality, the odds are stacked exceedingly in my favor, and given what little coverage I'm eligible for anyway, I don't have that much to lose in forgoing the insurance at this point. Yes, a tragedy absolutely could happen, but I'm just saying that I'm willing to bet that it won't (as I have up to this point) and I don't think I'm being irrational in doing so.

As an aside: In shopping around for insurance, I was also introduced to life insurance. I stated that I have no significant other or dependents whatsoever, so the insurance seller basically told me that my parents might be looking forward to my big doctor salary and that I might want to consider life insurance just for that! A lot of this is just manipulation by insurance companies!


I don't mean to say that I will wait until I've finished residency to get the insurance. Rather, I plan to wait until shortly before I finish so that I can be eligible to buy coverage for my large anticipated salary while still only having to pay a portion of my meager resident salary. And surely there are individual options for me rather than just employer-based coverage.

Thoughts?
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Re: Medical Resident: When Should I Get Disability Insurance

Post by BruDude »

newdoc wrote:I see, but the thing most likely to happen to my health status at this point is: nothing. Even if I somehow did wind up claiming disability, perhaps for a broken bone or a bout of depression, I would most likely be out of work for a couple of months at best. In any of these circumstances, I'd be able to get assistance from my family. Now, the chance of me being more substantially disabled somehow is indeed there, but it is exceedingly small and I feel that I'm being taken advantage of when insurance sellers tell a young, extremely healthy male like me, "You could be out for life." They're basically using fear mongering to get what they already know is an almost guaranteed $1,000/yr in revenue. In actuality, the odds are stacked exceedingly in my favor, and given what little coverage I'm eligible for anyway, I don't have that much to lose in forgoing the insurance at this point. Yes, a tragedy absolutely could happen, but I'm just saying that I'm willing to bet that it won't (as I have up to this point) and I don't think I'm being irrational in doing so.

As an aside: In shopping around for insurance, I was also introduced to life insurance. I stated that I have no significant other or dependents whatsoever, so the insurance seller basically told me that my parents might be looking forward to my big doctor salary and that I might want to consider life insurance just for that! A lot of this is just manipulation by insurance companies!


I don't mean to say that I will wait until I've finished residency to get the insurance. Rather, I plan to wait until shortly before I finish so that I can be eligible to buy coverage for my large anticipated salary while still only having to pay a portion of my meager resident salary. And surely there are individual options for me besides just the employer-based coverage.

Thoughts?
I think you're missing my point. The risk is not solely that you will become disabled while a resident, but that you could develop a health problem which could lead to restrictions or limitations placed on your policy during the underwriting of your application.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by campy2010 »

Agree with the above post. I'm in my early 30s, cyclist, runner, and by all accounts very healthy. But was diagnosed with a relatively serious condition while in grad school a few years ago. I was a student so I had no income to insure but now I'm essentially uninsuranble for the one condition for which I will likely need disability insurance. The chances of these things popping up only increase as you age. A little bit of guaranteed income protection is better than none at all.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by newdoc »

BruDude wrote:
newdoc wrote:I see, but the thing most likely to happen to my health status at this point is: nothing. Even if I somehow did wind up claiming disability, perhaps for a broken bone or a bout of depression, I would most likely be out of work for a couple of months at best. In any of these circumstances, I'd be able to get assistance from my family. Now, the chance of me being more substantially disabled somehow is indeed there, but it is exceedingly small and I feel that I'm being taken advantage of when insurance sellers tell a young, extremely healthy male like me, "You could be out for life." They're basically using fear mongering to get what they already know is an almost guaranteed $1,000/yr in revenue. In actuality, the odds are stacked exceedingly in my favor, and given what little coverage I'm eligible for anyway, I don't have that much to lose in forgoing the insurance at this point. Yes, a tragedy absolutely could happen, but I'm just saying that I'm willing to bet that it won't (as I have up to this point) and I don't think I'm being irrational in doing so.

As an aside: In shopping around for insurance, I was also introduced to life insurance. I stated that I have no significant other or dependents whatsoever, so the insurance seller basically told me that my parents might be looking forward to my big doctor salary and that I might want to consider life insurance just for that! A lot of this is just manipulation by insurance companies!


I don't mean to say that I will wait until I've finished residency to get the insurance. Rather, I plan to wait until shortly before I finish so that I can be eligible to buy coverage for my large anticipated salary while still only having to pay a portion of my meager resident salary. And surely there are individual options for me besides just the employer-based coverage.

Thoughts?
I think you're missing my point. The risk is not solely that you will become disabled while a resident, but that you could develop a health problem which could lead to restrictions or limitations placed on your policy during the underwriting of your application.
What I'm saying is that, given my age, my level of health, my medical history, my family medical history and my health practices, the chance of my health declining significantly in the near future is miniscule at best. And while certainly possible, I'm willing to bet that it won't...at least for a few more years. Is this irrational? Should I just bite the bullet and pay $1000+/yr to safeguard against some catastrophe that is almost certain not to happen in the next few years; can't I just wait until I'm 30 or something?

This brings me back to my original question: when is the time exactly right to purchase disability insurance? You guys seem to be suggesting that I should have disability insurance right out of the gate even though I'm still in my mid-20s. But no one has come out and stated this much which leads me to believe that I do in actuality have some leeway, especially considering my health history. Am I wrong to try to titrate out that perfect point when I should start? Are you indeed saying that I should just buck up and get coverage right this second?
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Re: Medical Resident: When Should I Get Disability Insurance

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newdoc wrote:What I'm saying is that, given my age, my level of health, my medical history, my family medical history and my health practices, the chance of my health declining significantly in the near future is miniscule at best. And while certainly possible, I'm willing to bet that it won't...at least for a few more years. Is this irrational? Should I just bite the bullet and pay $1000+/yr to safeguard against some catastrophe that is almost certain not to happen in the next few years; can't I just wait until I'm 30 or something?
Don't forget about accidents - there are a ton of possibilities here. Consider an occurrence where you might be temporarily out of work for 6 weeks. I've used my employer's short-term disability insurance (the occurrence was not not job related, but I couldn't work).
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Re: Medical Resident: When Should I Get Disability Insurance

Post by newdoc »

LadyGeek wrote:
newdoc wrote:What I'm saying is that, given my age, my level of health, my medical history, my family medical history and my health practices, the chance of my health declining significantly in the near future is miniscule at best. And while certainly possible, I'm willing to bet that it won't...at least for a few more years. Is this irrational? Should I just bite the bullet and pay $1000+/yr to safeguard against some catastrophe that is almost certain not to happen in the next few years; can't I just wait until I'm 30 or something?
Don't forget about accidents - there are a ton of possibilities here. Consider an occurrence where you might be temporarily out of work for 6 weeks. I've used my employer's short-term disability insurance (the occurrence was not not job related, but I couldn't work).
I have short term covered through family support and by my employer.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by neurosphere »

newdoc wrote: What I'm saying is that, given my age, my level of health, my medical history, my family medical history and my health practices, the chance of my health declining significantly in the near future is miniscule at best.
My wife was denied disability insurance outright, and she is in PERFECT health. Last year I was randomly assaulted. I was ok, but I looked like HELL. People would turn to look at me on the streets I looked so bad. My face was so bruised, eyes swollen, etc. Overall, I was FINE, simply cosmetic. And my wife knew I was fine. And two weeks later I was 100% back to normal (physically and cosmetically). But she developed some weird vague symptoms of tingling in her hands, which as a neurologist, I was almost certain was due to lingering anxiety about the fact that I could have been killed. But my wife is not my patient. So we went to see her internist, for a full checkup. He reassured her she would get better, and that it was likely related to my assualt. The next day her symptoms disappeared (as is common in these cases). 8 months later, she was denied disability insurance because of her "psychiatric condition". Yes, technically it is. Or it was. But they saw buzzwords in her doctors notes, likely "anxiety" or "conversion disorder" and just said "no".

The sad thing is that I was AFRAID this would happen. I KNEW we would be shopping for disability insurance and I KNEW that going to the doctor was a bad idea. So I had to wrestle with the decision. But it was the RIGHT thing to do for her.

The point is, you don't THINK anything will happen regarding your health. But there are ALL SORTS of scenarios you are not thinking about. Accidents/trauma for one. Do you drive? Then boy, you have one major major risk factor. Do you play sports? Intramural football, basket ball, perhaps? I see TONS of concussions from recreational sports, some with lingering effects for months to years. And even if you get better, one day you may apply for disability insurance and they'll say SURE we'll cover you, but we are going to exclude "anything to do with your head or brain".

So while you may decide that you will be healthy for the next few years, how the heck can you KNOW? If you can't afford coverage, that's one thing. But there are many good reasons to get coverage know, which INCLUDES the fact that you are young and healthy, which will make the coverage cheap and comprehensive.

My good buddy was diagnosed with multiple sclerosis in his last year of residency while his wife was pregnant with twins. I'm sure he wishes he had bought DI early on in residency.

NS

P.S. We are going to wait a little while and try again to purchase DI, but we have to keep our fingers crossed that nothing happens to her before we are able to get a policy in force.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by newdoc »

neurosphere wrote:
newdoc wrote: What I'm saying is that, given my age, my level of health, my medical history, my family medical history and my health practices, the chance of my health declining significantly in the near future is miniscule at best.
My wife was denied disability insurance outright, and she is in PERFECT health. Last year I was randomly assaulted. I was ok, but I looked like HELL. People would turn to look at me on the streets I looked so bad. My face was so bruised, eyes swollen, etc. Overall, I was FINE, simply cosmetic. And my wife knew I was fine. And two weeks later I was 100% back to normal (physically and cosmetically). But she developed some weird vague symptoms of tingling in her hands, which as a neurologist, I was almost certain was due to lingering anxiety about the fact that I could have been killed. But my wife is not my patient. So we went to see her internist, for a full checkup. He reassured her she would get better, and that it was likely related to my assualt. The next day her symptoms disappeared (as is common in these cases). 8 months later, she was denied disability insurance because of her "psychiatric condition". Yes, technically it is. Or it was. But they saw buzzwords in her doctors notes, likely "anxiety" or "conversion disorder" and just said "no".

The sad thing is that I was AFRAID this would happen. I KNEW we would be shopping for disability insurance and I KNEW that going to the doctor was a bad idea. So I had to wrestle with the decision. But it was the RIGHT thing to do for her.

The point is, you don't THINK anything will happen regarding your health. But there are ALL SORTS of scenarios you are not thinking about. Accidents/trauma for one. Do you drive? Then boy, you have one major major risk factor. Do you play sports? Intramural football, basket ball, perhaps? I see TONS of concussions from recreational sports, some with lingering effects for months to years. And even if you get better, one day you may apply for disability insurance and they'll say SURE we'll cover you, but we are going to exclude "anything to do with your head or brain".

So while you may decide that you will be healthy for the next few years, how the heck can you KNOW? If you can't afford coverage, that's one thing. But there are many good reasons to get coverage know, which INCLUDES the fact that you are young and healthy, which will make the coverage cheap and comprehensive.

My good buddy was diagnosed with multiple sclerosis in his last year of residency while his wife was pregnant with twins. I'm sure he wishes he had bought DI early on in residency.

NS

P.S. We are going to wait a little while and try again to purchase DI, but we have to keep our fingers crossed that nothing happens to her before we are able to get a policy in force.
I wish you and and your wife good luck in all this.

I see what you're saying and it's perfectly logical. But bringing up highly unlikely catastrophic events is what the insurance sellers have done with me as well: Of course it's possible that something bad might happen. But statistically, it's almost certainly not going to, especially at this time in my life. The scenarios you describe occur in maybe <1% of people in their mid-20s. I fully understand that I am assuming some risk in doing so, but why can't I, given my health history, spend perhaps just an extra year coasting on that other 99% and save myself $1,000? Is it irrational to propose doing so?
BruDude
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Re: Medical Resident: When Should I Get Disability Insurance

Post by BruDude »

newdoc wrote:I wish you and and your wife good luck in all this.

I see what you're saying and it's perfectly logical. But bringing up highly unlikely catastrophic events is what the insurance sellers have done with me as well: Of course it's possible that something bad might happen. But statistically, it's almost certainly not going to, especially at this time in my life. The scenarios you describe occur in maybe <1% of people in their mid-20s. I fully understand that I am assuming some risk in doing so, but why can't I, given my health history, spend perhaps just an extra year coasting on that other 99% and save myself $1,000? Is it irrational to propose doing so?
I've got plenty of stories from my "young and healthy" crowd of clients that are now still young but not quite as healthy as they used to be. One of my clients bought a health insurance policy from me at age 27, then was diagnosed with lung cancer at age 28 last year. He is not a smoker. Yes, you can save a few bucks and take your chances, but why take the risk for such a small savings versus knowing that you have 35+ years of comprehensive disability coverage that nobody can take away from you? That would be penny-wise and pound-foolish IMO. If your family is willing to help financially in the event of a short-term disability, maybe you can convince them to split the cost of the DI with you until you are out of residency.

The "it will never happen to me" response seems perfectly fine until it happens to you.
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newdoc
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Re: Medical Resident: When Should I Get Disability Insurance

Post by newdoc »

BruDude wrote:
newdoc wrote:I wish you and and your wife good luck in all this.

I see what you're saying and it's perfectly logical. But bringing up highly unlikely catastrophic events is what the insurance sellers have done with me as well: Of course it's possible that something bad might happen. But statistically, it's almost certainly not going to, especially at this time in my life. The scenarios you describe occur in maybe <1% of people in their mid-20s. I fully understand that I am assuming some risk in doing so, but why can't I, given my health history, spend perhaps just an extra year coasting on that other 99% and save myself $1,000? Is it irrational to propose doing so?
I've got plenty of stories from my "young and healthy" crowd of clients that are now still young but not quite as healthy as they used to be. One of my clients bought a health insurance policy from me at age 27, then was diagnosed with lung cancer at age 28 last year. He is not a smoker. Yes, you can save a few bucks and take your chances, but why take the risk for such a small savings versus knowing that you have 35+ years of comprehensive disability coverage that nobody can take away from you? That would be penny-wise and pound-foolish IMO. If your family is willing to help financially in the event of a short-term disability, maybe you can convince them to split the cost of the DI with you until you are out of residency.

The "it will never happen to me" response seems perfectly fine until it happens to you.
Fair enough. But should I get it right this second or can I afford to wait a year?
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Re: Medical Resident: When Should I Get Disability Insurance

Post by BruDude »

newdoc wrote:Fair enough. But should I get it right this second or can I afford to wait a year?
I would always recommend buying DI sooner rather than later if you're in good health. I bought my own DI policy at age 24.
Valuethinker
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Re: Medical Resident: When Should I Get Disability Insurance

Post by Valuethinker »

newdoc wrote:I just read through the whitecoatinvestor.com articles. It sure is complicated, but my fundamental question is this:

Can I, as a 1st-year resident physician, continue to go without disability insurance under the assumption that my health will probably go unchanged in the near future? Or is this a silly gamble not worth the $1000 that I would save?
In my view it is a silly gamble. People get degenerative diseases like MS and become uninsurable. They have major car accidents and back injury etc.
If I can go without it as a 1st year resident, what about as a 2nd, 3rd, 4th or 5th-year resident?

In other words, I of course plan to get disability at some point, but when exactly is the right time? Right out of med school, in the middle of residency, towards the end of residency or as a new attending physician?

Thanks
I would get early then upgrade cover with another policy later.
Valuethinker
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Re: Medical Resident: When Should I Get Disability Insurance

Post by Valuethinker »

BruDude wrote:
newdoc wrote:I wish you and and your wife good luck in all this.

I see what you're saying and it's perfectly logical. But bringing up highly unlikely catastrophic events is what the insurance sellers have done with me as well: Of course it's possible that something bad might happen. But statistically, it's almost certainly not going to, especially at this time in my life. The scenarios you describe occur in maybe <1% of people in their mid-20s. I fully understand that I am assuming some risk in doing so, but why can't I, given my health history, spend perhaps just an extra year coasting on that other 99% and save myself $1,000? Is it irrational to propose doing so?
I've got plenty of stories from my "young and healthy" crowd of clients that are now still young but not quite as healthy as they used to be. One of my clients bought a health insurance policy from me at age 27, then was diagnosed with lung cancer at age 28 last year. He is not a smoker. Yes, you can save a few bucks and take your chances, but why take the risk for such a small savings versus knowing that you have 35+ years of comprehensive disability coverage that nobody can take away from you? That would be penny-wise and pound-foolish IMO. If your family is willing to help financially in the event of a short-term disability, maybe you can convince them to split the cost of the DI with you until you are out of residency.

The "it will never happen to me" response seems perfectly fine until it happens to you.
Even if you survive many illnesses like cancer at a young age, you can become effectively uninsurable or only insurable at unaffordable rates.

For example, I had a knock on the head from being hit by a bicycle. I then found I was uninsurable for new life insurance (not sure what the position is now, but that was true 15 months after the accident). Fortunately I was already insured and exercised an option to increase my insurance cover.

i have no apparent long term side effects from the accident, scan was clean. But I was rendered uninsurable.
Valuethinker
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Re: Medical Resident: When Should I Get Disability Insurance

Post by Valuethinker »

newdoc wrote:I wish you and and your wife good luck in all this.

I see what you're saying and it's perfectly logical. But bringing up highly unlikely catastrophic events is what the insurance sellers have done with me as well: Of course it's possible that something bad might happen. But statistically, it's almost certainly not going to, especially at this time in my life. The scenarios you describe occur in maybe <1% of people in their mid-20s. I fully understand that I am assuming some risk in doing so, but why can't I, given my health history, spend perhaps just an extra year coasting on that other 99% and save myself $1,000? Is it irrational to propose doing so?
I think that you do not understand statistics, fully.

Statistics says over a population of millions you have 1/100 chance of being disabled. Statistically, your expected value of premiums paid in is ALWAYS less than your expected returns (chance of disability x amount of average payout). That's how insurance works, and is just as true of car, house insurance etc. (the insurance company also takes out a profit, sales commission, but they may make some investment return-- right now investment returns are pretty awful).

But if it happens to you, you cease to be a statistic. Suddenly you become Probability = 1.0.

You have to look at the expected utility of a loss vs. the expected utility of $1000 pa on something else for 1-5 years.

I think you'll find the loss to your life of being fully or partially disabled far exceeds any possible gain from that $1000 or $5k.
stjoe56
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Re: Medical Resident: When Should I Get Disability Insurance

Post by stjoe56 »

Years ago, I bought a long-term disability coverage. A few years ago, I asked myself, why was I paying for this coverage. I was a 10 years away from retirement and had more than enough to retire. But then as my wife pointed out, the premiums were relatively inexpensive. So I kept it. Lo and behold I got sick and ended up collecting. I am now getting $XXXX dollars a month tax free. I will continue to collect it for the next five years until I turn 65. It took 2-3 months of benefits to repay me for all the premiums I had paid over the years.

Right now I have a tenant. She bought a policy when she was 27 (?). Within a year she got sick and is now collecting on it.

The purpose of insurance is to insure against those things we cannot self insure against.

So if you can afford it, buy it now. You may feel invincible, but you aren't.

SJ
Bobbybell
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Re: Medical Resident: When Should I Get Disability Insurance

Post by Bobbybell »

dhodson wrote:yep its not true that you save money by buying as a resident

you just guarantee coverage since its already in force period.

cost is always a percentage of amount protected.

if they are telling you otherwise then i would consider telling your dept not to let this person back.

be very careful since i suspect they will also tell you to purchase permanent life insurance like whole life and that is highly unlikely to be a product that you should purchase.

although one of the other posters mentioned taking the gamble, typicaly the best advice isnt to gamble and lock in coverage with the ability to purchase further protection as your income rises (this will cost more period).

i am a physician and id say purchase as soon as it isnt a super hardship. Id look for own occ coverage. I also second looking at whitecoatinvestor.com for information on this. once you read his posts then come back and ask some more questions.
In many cases, residents can buy it at a big cost savings. The financial advisors who have an "in" to their program usually have sold significant amounts of disability coverage to residents. This allows them to offer group discounts. These discounts can be quite significant. This is especially true for females since they are done with sex neutral pricing.

Additionally, residents can buy more coverage than their income allows, thus locking them into a price at a younger age. Future insurability option riders protects them from future health changes.

I don't know what it means that "cost is always a percentage of amount protected". Cost is a dollar amount based upon age of purchase, amount of coverage, sex (if sex distinct pricing), health, riders, group discounts, occupation, and policy specifics.

If something happens to you today, do you need the benefit? If so, buy the coverage.
Big Worm
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Re: Medical Resident: When Should I Get Disability Insurance

Post by Big Worm »

From another physician, do it now.

You are a fool if you don't.

I know three people personally that went out just within memory. They were probably somewhat older than you but healthy otherwise. One had cancer and died, one had MS and can't work and one had a mysterious illness that put him out for several years.

The insurance companies are filled with [disreputable people --admin LadyGeek]. The underwriters are even worse. They don't have a clue when it comes to medical issues. Any blip at all on your medical records is cause for denial.

I got a cheap policy as a resident. About $1200 per year for $3500/month very strong coverage and I still have the policy. It makes it easier to get more coverage in the future although you still will probably have to go through the underwriting process if you want more.
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Zeppcoustic
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Re: Medical Resident: When Should I Get Disability Insurance

Post by Zeppcoustic »

Definitely get it. It should be affordable. I pay $51 a month to Guardian for a $4k monthly benefit after discounts. I am a radiology resident, class 4M.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by BruDude »

Zeppcoustic wrote:Definitely get it. It should be affordable. I pay $51 a month to Guardian for a $4k monthly benefit after discounts. I am a radiology resident, class 4M.
That sounds really low even for a graded premium. No COLA/FIO/residual?
stjoe56 wrote:Years ago, I bought a long-term disability coverage. A few years ago, I asked myself, why was I paying for this coverage. I was a 10 years away from retirement and had more than enough to retire. But then as my wife pointed out, the premiums were relatively inexpensive. So I kept it. Lo and behold I got sick and ended up collecting. I am now getting $XXXX dollars a month tax free. I will continue to collect it for the next five years until I turn 65. It took 2-3 months of benefits to repay me for all the premiums I had paid over the years.

SJ
DI purchased while young becomes an incredibly good deal as you get older since the premiums are only a fraction of what you would pay to buy a new policy at an older age. My dad is in his 60's, now with multiple health issues, and still pays only about $1000/year for his DI policy that he bought 30 years ago. Even if you don't "need" it at an older age, the chances of becoming disabled and collecting make the premiums relatively insignificant by comparison.
Bobbybell wrote:In many cases, residents can buy it at a big cost savings. The financial advisors who have an "in" to their program usually have sold significant amounts of disability coverage to residents. This allows them to offer group discounts. These discounts can be quite significant. This is especially true for females since they are done with sex neutral pricing.

Additionally, residents can buy more coverage than their income allows, thus locking them into a price at a younger age. Future insurability option riders protects them from future health changes.

I don't know what it means that "cost is always a percentage of amount protected". Cost is a dollar amount based upon age of purchase, amount of coverage, sex (if sex distinct pricing), health, riders, group discounts, occupation, and policy specifics.

If something happens to you today, do you need the benefit? If so, buy the coverage.
Unisex rates plus a discount are actually a bad deal for male residents since the unisex rates offset the discount they get. Being able to get a 10% discount with gender-distinct rates is a better deal for men, but for women the unsiex rates and discount can yield a 20-40% total savings versus buying a policy with gender-distinct rates.
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matjen
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Re: Medical Resident: When Should I Get Disability Insurance

Post by matjen »

I have sort of the opposite scenario that I have been struggling with. Married an ER Physician about 1.5 years ago and spent the first 6 months straightening out her finances (typical Dr. abuse from insurance salesman).

Amazingly, she got the whole life and the loaded crappy mutual funds but didn't get the disability insurance. I was all set to remedy that right after the finances but have put it on the back burner. Between the two of us we have already won the game but we are still kind of young. I am 47 and she is 41. Worth mid-7 figures and have no children though one is a possibility. Moving forward she will be the main breadwinner but my portfolio is much larger.

Can someone set me straight? What would you do? I think it is a closer call once you already have substantial assets.
A man is rich in proportion to the number of things he can afford to let alone.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by Bobbybell »

The savings are less for men, but I have never seen a situation when the discount resulted in no savings. Also, most of what I have seen in the resident market has been at a 25% sex neutral rating resulting in about a 40% savings for females and 15% for men.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by BruDude »

Bobbybell wrote:The savings are less for men, but I have never seen a situation when the discount resulted in no savings. Also, most of what I have seen in the resident market has been at a 25% sex neutral rating resulting in about a 40% savings for females and 15% for men.
I just ran a sample quote with Guardian for a 30-year old male with a 4M occupation class, 90-day elimination period, age-65 benefit period, $5k/mo total disability benefit, $12k/mo FIO, 3% COLA, Residual rider. The premium for gender-distinct rates with 10% discount was $2191 and the premium for unisex rates with 10% discount was $2773. For a female with the same figures the premium with gender-distinct rates is $3484 and with the unisex rates is $2773. Without a discount the gender-distinct rates are $2434 for male and $3871 for female.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by lightheir »

FWIW, I had very few funds to work with as a resident, and ended up not getting the disability insurance then because I simply couldn't afford it.

I got it as a new attending 2 years after graduating, and it was MUCH, MUCH more affordable with the increase in income that comes with becoming an attending.

I do understand that it makes sense healthwise to get it as early as possible, since you're locking in your premiums at your best health if you do it early, but honestly, I felt the 2-year wait was completely worth it given how much easier (nearly trivial) it was to pay for the insurance as an attending as compared to doing it as a resident.

I'm actually surprised that the salespeople come out so hard in residency (they come out HARD.) It's so much of an easier sell as a new attending with the income - nearly a no-brainer at that point, whereas it can be a major financial strain in residency.
nonnie
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Re: Medical Resident: When Should I Get Disability Insurance

Post by nonnie »

newdoc wrote: Fair enough. But should I get it right this second or can I afford to wait a year?
I don't know-- is the unexpected car crash or degenerative disease you don't expect going to happen in six months, a year, three years or never? You keep asking the question and you keep getting the same answer-- do it now. I speak from the experience of going on total disability at age 47 and collecting for 18 years--totally unexpected spinal degeneration. Before I met him, my partner had started collecting disability--totally unexpected illness/condition. A couple years ago a car ran into his 21 year old son while he was riding his bike-- smashed his ankle. He's mostly OK with slight impairment in that leg-- he can't get disability insurance. This kid's hobby was stunt bike riding (accident happened on city street). He didn't think it could happen to him...
dwade1109
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Re: Medical Resident: When Should I Get Disability Insurance

Post by dwade1109 »

Wow, as a resident I had not even thought about disability insurance.

Right now according to my hospital's website I have "at no cost to employee while in training 60% of monthly basic earnings, to a maximum of $3,500/month." I make like 50k a year, so pretax like 4.1k a month, meaning 60% is 2.4k. Seems pretty low. Should I be looking for my own individual plan?
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Re: Medical Resident: When Should I Get Disability Insurance

Post by BruDude »

dwade1109 wrote:Wow, as a resident I had not even thought about disability insurance.

Right now according to my hospital's website I have "at no cost to employee while in training 60% of monthly basic earnings, to a maximum of $3,500/month." I make like 50k a year, so pretax like 4.1k a month, meaning 60% is 2.4k. Seems pretty low. Should I be looking for my own individual plan?
Most residents have group coverage but you should still get an individual policy. Residency is the only time that group coverage will not be counted against the allowable amount of individual DI. The group DI is also not going to be nearly as comprehensive as an individually purchased policy.
dwade1109
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Re: Medical Resident: When Should I Get Disability Insurance

Post by dwade1109 »

BruDude wrote:
dwade1109 wrote:Wow, as a resident I had not even thought about disability insurance.

Right now according to my hospital's website I have "at no cost to employee while in training 60% of monthly basic earnings, to a maximum of $3,500/month." I make like 50k a year, so pretax like 4.1k a month, meaning 60% is 2.4k. Seems pretty low. Should I be looking for my own individual plan?
Most residents have group coverage but you should still get an individual policy. Residency is the only time that group coverage will not be counted against the allowable amount of individual DI. The group DI is also not going to be nearly as comprehensive as an individually purchased policy.
So we get advertisments all the time in the mail about DI. How to know how to choose a good one? What are the most important factors?
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Re: Medical Resident: When Should I Get Disability Insurance

Post by Bobbybell »

BruDude wrote:
Bobbybell wrote:The savings are less for men, but I have never seen a situation when the discount resulted in no savings. Also, most of what I have seen in the resident market has been at a 25% sex neutral rating resulting in about a 40% savings for females and 15% for men.
I just ran a sample quote with Guardian for a 30-year old male with a 4M occupation class, 90-day elimination period, age-65 benefit period, $5k/mo total disability benefit, $12k/mo FIO, 3% COLA, Residual rider. The premium for gender-distinct rates with 10% discount was $2191 and the premium for unisex rates with 10% discount was $2773. For a female with the same figures the premium with gender-distinct rates is $3484 and with the unisex rates is $2773. Without a discount the gender-distinct rates are $2434 for male and $3871 for female.
Like I said, most of what I have seen in the resident market has been at a 25% sex neutral discount. If someone is truly selling in this market, they should have enough business where they are able to get a discount that is larger than 10%.
lightheir
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Re: Medical Resident: When Should I Get Disability Insurance

Post by lightheir »

nonnie wrote:
newdoc wrote: Fair enough. But should I get it right this second or can I afford to wait a year?
I don't know-- is the unexpected car crash or degenerative disease you don't expect going to happen in six months, a year, three years or never? You keep asking the question and you keep getting the same answer-- do it now. I speak from the experience of going on total disability at age 47 and collecting for 18 years--totally unexpected spinal degeneration. Before I met him, my partner had started collecting disability--totally unexpected illness/condition. A couple years ago a car ran into his 21 year old son while he was riding his bike-- smashed his ankle. He's mostly OK with slight impairment in that leg-- he can't get disability insurance. This kid's hobby was stunt bike riding (accident happened on city street). He didn't think it could happen to him...
ALthough you do have to consider that it's highly unlikely that a disability policy for a doctor will pay out for that ankle injury long-term. Most MDs can get by just fine with a complete ankle replacement to do their job amply, which is the main criteria at which point disability pays in. You'd have better luck with a disabling back injury getting it to pay out.
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Re: Medical Resident: When Should I Get Disability Insurance

Post by Bobbybell »

lightheir wrote:FWIW, I had very few funds to work with as a resident, and ended up not getting the disability insurance then because I simply couldn't afford it.

I got it as a new attending 2 years after graduating, and it was MUCH, MUCH more affordable with the increase in income that comes with becoming an attending.

I do understand that it makes sense healthwise to get it as early as possible, since you're locking in your premiums at your best health if you do it early, but honestly, I felt the 2-year wait was completely worth it given how much easier (nearly trivial) it was to pay for the insurance as an attending as compared to doing it as a resident.

I'm actually surprised that the salespeople come out so hard in residency (they come out HARD.) It's so much of an easier sell as a new attending with the income - nearly a no-brainer at that point, whereas it can be a major financial strain in residency.
There is a very good reason why they come out so hard in residency. It is a very smart long term business decision for the agents who specialize in the medical market. They don't care about getting your business as a resident. They don't make that much money on it. They want your business when you go from making $50,000 to making $300,000. The best way to get your business when you are making $300,000 is to get you as a client when you are making $50,000.

Use yourself as an example. If an agent came after you as a resident and presented himself in a professional manner and you chose not to buy coverage because of the finances, don't you think that he would have a very good shot of getting your business when you became an attending? If he didn't come after you as a resident, he would have virtually no chance to get your business as an intending.

I have friends who make 7 figures who have built their entire practice on going after residents. Their income from getting the new residents doesn't come close to covering their expenses. However, if they get 50 new residents as clients, it means that they have 50 new clients who will have 6 figure incomes in the future.
staythecourse
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Re: Medical Resident: When Should I Get Disability Insurance

Post by staythecourse »

lightheir wrote:ALthough you do have to consider that it's highly unlikely that a disability policy for a doctor will pay out for that ankle injury long-term. Most MDs can get by just fine with a complete ankle replacement to do their job amply, which is the main criteria at which point disability pays in. You'd have better luck with a disabling back injury getting it to pay out.
No offense, but it is not right giving misinformation. A disability carrier can not make you get surgery only reasonable medical treatment from a specialist in that field. There was even recently a law suit of one denying a claim to surgeon or OB stating they wanted him/ her to have a carpal tunnel release and he refused. ALL surgeries have possible complications and that is one reason they can't force you.

Not sure what happened in that case, but that was just for a 20 min. carpal tunnel release. Imagine them trying to force a total ankle replacement on someone.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle
dhodson
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Re: Medical Resident: When Should I Get Disability Insurance

Post by dhodson »

staythecourse wrote:
lightheir wrote:ALthough you do have to consider that it's highly unlikely that a disability policy for a doctor will pay out for that ankle injury long-term. Most MDs can get by just fine with a complete ankle replacement to do their job amply, which is the main criteria at which point disability pays in. You'd have better luck with a disabling back injury getting it to pay out.
No offense, but it is not right giving misinformation. A disability carrier can not make you get surgery only reasonable medical treatment from a specialist in that field. There was even recently a law suit of one denying a claim to surgeon or OB stating they wanted him/ her to have a carpal tunnel release and he refused. ALL surgeries have possible complications and that is one reason they can't force you.

Not sure what happened in that case, but that was just for a 20 min. carpal tunnel release. Imagine them trying to force a total ankle replacement on someone.

Good luck.
he isnt the one giving misinformation. first he never said that anyone would force surgery on someone. He was just rightly pointing out that such an injury isnt as likely to result in a long term situation where a doctor cant perform their job and the insurance will pay out. Its possible but not as likely.
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