OB-GYN Long-Term Disability Claim Denial – We Can Help
As an OB/GYN, your professional life is a study in extremes. You are a surgeon, a primary care provider, a counselor, and an emergency responder, often all in the same day. You navigate the profound joy of childbirth and the deep complexities of gynecological surgery. Your “normal” includes 3 AM emergency C-sections, 14-hour days on your feet, and the emotional and cognitive stamina to make life-or-death decisions when you are sleep-deprived.
Your career is uniquely grueling, both physically and mentally. There is no “light duty” in obstetrics. You cannot partially deliver a baby, and you cannot have an “off day” during a complex laparoscopic hysterectomy.
It is a devastating betrayal, then, when your own health fails and the disability insurance company you trusted denies your claim. The denial letter often exposes a complete and willful misunderstanding of what your job actually entails. They may argue that your back pain doesn’t prevent you from “consulting with patients” or that your hand tremor doesn’t stop you from “office work.”
They have dangerously simplified your career, and they are counting on you to be too sick and too exhausted to fight back.
At Uscher, Quiat, Uscher & Russo, P.C., we have been representing physicians for decades. We understand the specific, high-stakes reality of your “dual specialty” and the flawed tactics insurers use to deny your claim. We build a case that proves not just what you did, but what it took to do it.
The “Dual Specialty” Trap: The Insurer’s Divide-and-Conquer Tactic
The most common strategy used to deny an OB/GYN is to split your occupation in two. The insurer will concede that your disability (e.g., a degenerative disc disease or a neurological tremor) prevents you from performing one part of your job, while arguing you can still perform the other.
- “If you can’t be an Obstetrician, be a Gynecologist.” They will claim that your disabling condition only prevents the “OB” part of your practice—the unpredictable hours, the late-night deliveries, the running to the OR. They will argue that you can still maintain a “reasonable” schedule seeing GYN patients in a clinic.
- “If you can’t perform Surgery, you can do Clinic Work.” They will take it a step further. They’ll concede that your cervical spine disease or carpal tunnel stops you from performing surgery. Then, they will argue that your “Own Occupation” is not “OB/GYN surgeon” but simply “physician,” and that you can still earn a living by only doing exams, consults, and non-procedural work.
This is a disingenuous and often bad-faith interpretation of your profession. You weren’t trained as a “clinic-only” doctor. You were trained as a highly skilled OB/GYN, and your market value is tied to your ability to perform the full scope of your duties—surgical, obstetrical, and clinical.
We fight this by proving your occupation is non-divisible. We gather evidence from your medical group, hospital credentialing bodies, and vocational experts to establish that the material duties of an OB/GYN include surgical skills, physical stamina for deliveries, and the ability to be on-call. We don’t let them rewrite your job description to save themselves money.
Proving the Unprovable: When Your Hands or Body Fail You
For many OB/GYNs, the disability is clear and physical, yet the insurer still denies it. They claim your symptoms are “subjective” or that the “objective evidence” doesn’t support a total disability.
- The Surgeon’s Hands: A subtle essential tremor, a loss of sensation from carpal tunnel, or advancing arthritis in your hands might be a minor inconvenience for someone else. For you, it’s a career-ending event. It makes laparoscopic procedures unsafe and delicate surgical work impossible. We work to objectify this limitation with Functional Capacity Evaluations (FCEs) focused on fine motor skills and reports from specialists that explain, in no uncertain terms, why this limitation is disqualifying for a surgeon.
- The Physical Toll: Years of standing in the OR, leaning over patients, and wearing heavy lead aprons destroy your spine. A degenerative disc disease or chronic back pain is one of the most common reasons OB/GYNs must stop working. The insurer will send your file to a “paper-only” doctor who will claim your MRI “isn’t that bad” and that you can perform “sedentary” work. This ignores the 12-hour shifts, the stamina required for a long delivery, and the physical strength needed in the OR. We build a case that proves your job is classified as “medium” or “heavy” work, not the “light” desk job the insurer pretends it is.
The “Invisible” Illness: Burnout, Cognitive Fog, and Mental Health
OB/GYN has one of the highest rates of physician burnout in all of medicine. The relentless stress, the emotional toll, and the sleep deprivation can lead to severe Major Depressive Disorder, anxiety, and profound cognitive fatigue.
Insurers are notoriously skeptical of these “invisible” disabilities. They will deny your claim, stating that “burnout is not a disability” or that you lack “objective evidence” of your condition.
At UQUR, we know this is not “just burnout.” It is a clinically diagnosable condition, and we know how to prove it.
We counter their skepticism by gathering definitive, objective evidence. We work with neuropsychologists to conduct extensive testing that quantifies your cognitive decline. These reports provide hard data on your loss of processing speed, memory deficits, and executive dysfunction. We build the case that while you may look fine, your cognitive function is no longer at the high-capacity level required to safely manage a high-risk pregnancy or a surgical complication. A simple memory lapse, for you, could be catastrophic for a patient.
The ERISA Nightmare: Why Your Appeal Is Your One and Only Trial
If your disability policy is through your employer or hospital group, your claim is governed by a federal law called ERISA. This law is complex, counter-intuitive, and heavily stacked in the insurance company’s favor.
Under ERISA, there is one rule that can make or break your entire case: The Administrative Record.
When an insurer denies your claim, you must go through their internal appeal process. What they don’t tell you is that this appeal is your one and only chance to submit evidence. Everything you submit—every medical record, expert report, and doctor’s letter—becomes part of the “Administrative Record.”
If your appeal is denied and you are forced to sue the insurance company, the federal judge is generally forbidden from looking at any new evidence. They can only review the Administrative Record that you (or your attorney) built.
This is the trap. If you submit a weak appeal—or worse, have a lawyer who offers a “free” appeal by just writing a letter—you have permanently crippled your case. You cannot add the crucial vocational reports, FCEs, or neuropsychological testing later.
The appeal is your trial. You must treat it as such.
The UQUR Strategy: A Trial-Ready Case from Day One
When you hire Uscher, Quiat, Uscher & Russo, P.C., you are hiring a team of expert ERISA attorneys. We build your appeal as if we are already preparing for federal court. Our process is meticulous and designed to build an Administrative Record so strong that the insurer is forced to reconsider, or we are fully prepared to win a lawsuit.
- Forensic Denial Analysis: We deconstruct your denial letter line by line. We identify the “paper-only” doctors they used, the evidence they ignored, and the logical fallacies in their medical review.
- Prove Your “True Occupation”: We don’t let them define your job. We hire a Vocational Expert to write a detailed report on the actual physical, surgical, cognitive, and mental demands of a practicing OB/GYN, including the on-call burden.
- Build a Mountain of Objective Evidence: We commission the powerful, independent reports the insurer hopes you won’t get. This includes FCEs for physical claims, neuropsychological evaluations for cognitive claims, and compelling narrative reports from your own treating doctors.
- Execute a Legal Strategy: We frame all this evidence within a powerful legal argument that methodically dismantles the insurer’s reasoning and proves you meet your policy’s definition of “total disability.”
You have spent your entire career caring for others in their most vulnerable moments. Now that you are the one who is vulnerable, you deserve an advocate who will fight for you with the same level of expertise and dedication.
Your time to appeal is short. Contact Uscher, Quiat, Uscher & Russo, P.C. today for a confidential consultation. Let us take on the insurance company, so you can focus on your health.
New Jersey Office