TJ PorterBy T.J. Porter, WCI Contributor

One of the greatest financial risks that doctors face is a loss of their ability to earn an income. If you get injured and become disabled, you could find yourself forced to leave a career you spent years and hundreds of thousands of dollars to attain. Disability insurance can help protect you from that possibility. Keep in mind, though: if you’re buying disability coverage, especially if you’re getting it privately rather than through an employer, there’s a good chance the insurer will want to conduct a medical exam to make sure you’re a good insurance risk.

During that exam, they’ll be looking for a few specific things.

 

What Are They Looking for at a Medical Exam for Disability Insurance?

When you apply for disability insurance, the insurance provider will usually schedule a medical exam as part of the underwriting process. This exam serves two purposes: to understand your baseline health and to confirm that you’re not at a very high risk of getting disabled. 

During the exam, you’ll answer questions about your medical history and get a physical examination. You may also have to discuss things like your hobbies, because dangerous hobbies could increase your insurance risk.

Generally, the healthier you are, the cleaner your personal and family medical history are, and the less risky your hobbies are, the more likely you are to qualify for coverage (and your premiums will probably be lower as a result). Other factors, like your age and gender, will also play a role.

Some specific things that the exam will ask about or look for include:

  • Blood and urine samples
  • Height and weight
  • Blood pressure
  • Current and previous health issues
  • Family medical history
  • Your history of smoking, drinking, or drug use
  • Current medications
  • Previous hospitalizations, if any
  • Signs of disease or conditions—such as diabetes, hepatitis, high blood pressure or cholesterol, or mental disorders

More information here:

How Much Disability Insurance Should You Buy?

 

What Disqualifies You from Disability Insurance?

The insurance industry is all about risk. Insurers only offer policies to people that they believe, on average, are likely to be profitable to insure. If you have a very high risk of becoming disabled and filing a claim, an insurer is likely to charge an exorbitant premium or deny you coverage entirely.

Having high-risk habits, such as smoking or drug use, can lead to exclusions or even outright denial. You might also have trouble getting insurance if you have dangerous hobbies. Someone who goes skydiving every weekend, for example, is much riskier to insure than a homebody who prefers to read or watch sports on their off days.

There can also be situations where you won’t receive an outright denial but may need to wait before beginning coverage. For example, if you have a medical procedure scheduled, such as surgery, the insurer will probably want to wait until after you recover to start your policy.

 

What If I Have Preexisting Conditions? Will I Get Denied?

Pre-existing conditions are another major reason that you could face exclusions or declination for disability insurance. You need to buy insurance before you become disabled and are unable to work, so if you’re already struggling to do your job due to a disability, you won’t be able to get coverage.

Even if your condition isn’t yet affecting your job, it could still lead to a denial. For example, a physician who is developing arthritis may not be totally incapable of working but will struggle to find a willing insurer, given that the arthritis is likely to continue to develop and worsen over time.

If you have a condition where you may get denied coverage or receive exclusions on your policy, you might consider Guaranteed Standard Issue (GSI) disability insurance. This type of coverage does not require a medical exam. However, it is usually more expensive and less customizable than other forms of disability insurance.

More information here:

What are disability exclusions or limitations

Guaranteed Standard Issue (GSI) vs. Traditional Disability Insurance

How to Get Disability Insurance Coverage Without a Medical Exam

 

Do They Drug Test for Disability Insurance?

medical exam disability insurance

Yes, almost every insurance provider will conduct a blood and urine test when you apply for disability insurance. These tests will turn up any drugs that may be present, including nicotine, THC, and other illicit drugs. The insurer can also use the blood test to check for conditions such as HIV/AIDS, diabetes, or high cholesterol.

 

What Happens If You Fail a Drug Test?

If you fail a drug test while applying for disability insurance, it may affect whether the insurer will offer coverage. Drug use is typically seen as a high-risk activity. At best, you’ll have to pay more for coverage. At worst, you’ll get denied coverage.

If you’ve filed a claim for disability coverage and later fail a drug test, what follows will depend on your insurer, your reason for filing the claim, and the information you provided when filing your claim. If you hid or lied about drug use when filing the claim, especially if the condition that resulted in your claim could be related to drug use, it may affect your eligibility for benefits.

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