Blood-borne Pathogens - A Career Breaker?

John Brown
John Brown Insurance
Special to the COA Bulletin

Toronto, ON

The College of Physicians and Surgeon Ontario (and other provincial colleges) position on contraction of HIV, HBV or HCV by a physician is very clear:

"If a physician who performs exposure-prone procedures learns that he or she is positive for HIV, HBV or HCV, he or she is ethically obligated to contact the College for a review of whether his or her serologic status will have an effect on his or her medical practice. The College will take such steps as are necessary, as authorized by the legislation, to ensure that practice modifications, if any, that are appropriate to the situation are made. In doing so, the College will consult and receive advice from experts in the field."

 

A reasonable assumption is that "practice modifications" could mean prohibiting a surgeon from performing exposure prone procedures. For an orthopaedic surgeon, that could mean the end of performing surgery.

How do you protect yourself against this potential loss of income?

Fortunately, the insurance industry has developed a few partial solutions. I say partial because the industry does not want you to have more monthly disability insurance benefit than your monthly, take-home income.

Critical Illness Insurance

Critical Illness Benefit: The basic policy provides the owner with a tax-free lump-sum benefit if you have a critical illness which meets one of the definitions set out in the policy and the survival period is satisfied. The survival period is usually 30 days (some exceptions apply). During the survival period you must not have experienced irreversible cessation of all functions of the brain. Among those 24 covered conditions is Occupational HIV Infection.

Should the insured be diagnosed with and survive one of the 24 critical illnesses, a lump-sum benefit will be payable to the owner 30 days after the diagnosis or surgery (some exceptions apply). The 24 critical illnesses are shown below:

Alzheimer's Disease, Aortic Surgery, Aplastic Anaemia, Bacterial Meningitis, Benign Brain Tumour, Blindness, Coma, Coronary Artery Bypass, Deafness, Heart Attack, Heart Valve Replacement, Kidney Failure, Life-Threatening Cancer, Loss of Limbs, Loss of Speech, Major Organ Failure on Waiting List, Major Organ Transplant, Motor Neuron Disease, Multiple Sclerosis, Occupational HIV Infection, Paralysis, Parkinson's Disease, Severe Burns, and Stroke. Loss of independent existence can be added as an additional covered condition.

Occupational HIV Infection means infection with human immunodeficiency virus (HIV) resulting from accidental injury during the course of your normal occupation, which exposed the person to HIV contaminated body fluids. The accidental injury leading to the infection must have occurred following the later of the date of issue of the policy or the effective date of last reinstatement of the policy.

Payment under this condition requires satisfaction of all of the following:

a)    the accidental injury must be reported to the insurer within 14 days of the accidental injury;
b)    a serum HIV test must be taken within 14 days of the accidental injury and the result must be negative;
c)     a serum HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive;
d)    all HIV tests must be performed by a duly licensed laboratory in Canada or the United States; and
e)    the accidental injury must have been reported, investigated and documented in accordance with current Canadian or United States workplace guidelines.

Exclusions: No benefit will be payable under this critical illness insured condition if:

a)    you have elected not to take any available licensed vaccine offering protection against HIV; or
b)    a licensed cure for HIV infection has become available prior to the accidental injury.

For greater certainty, non-accidental injury including, but not limited to, sexual transmission or intravenous (IV) drug use does not satisfy the definition of Occupational HIV Infection.

Disability Insurance

General Definition of Total Disability:
During the first 24 months, total disability means, due to injury or sickness, you cannot perform the substantial duties of your regular occupation and you are not working in any gainful occupation. Thereafter, you are totally disabled if you cannot work in any gainful occupation.

Own Occupation Definition of Total Disability:
Purpose: Professionals often have a significant investment in their occupation, including years of training and acquired experience. However, many feel that although they might be able to find alternative employment during a total disability, they would experience a drastic reduction in income. The Own Occupation Rider allows you to work in another occupation while you are totally disabled in your regular occupation and continue to receive disability benefits.

Specifics: The Own Occupation Rider modifies the definition of total disability under the basic policy so you will be considered to be totally disabled even if you engage in any other gainful occupation.

Health Care Profession Rider:
Purpose: If a health care professional were to become infected with HIV, hepatitis B or hepatitis C, it could have career implications. Although the health care professional may be fully functional, legislation or regulations may prohibit you from performing the substantial duties of your occupation. In such a case, it is possible that disability benefits may not be payable, as you may not be physically disabled at the time. The Health Care Profession Rider helps remove this doubt.

Specifics: You will be considered totally disabled due to sickness if, you are infected with HIV, hepatitis B or hepatitis C infection, and as a direct result, a law or medical/dental regulatory or licensing body prohibits you:

  • from performing one or more of the substantial duties of your regular occupation, or
  • you are required to disclose an infected condition to patients.

Currently, no premium is payable for this rider. However, the insurance company reserves the right to charge a premium in the future. If a premium is charged for this rider, it can only be changed at the end of every five-year period.

Summary

  1. Critical Illness insurance can be added on top of all disability income plans.
  2. Critical Illness insurance is not financially underwritten. You do not have to have "proof of income".
  3. Maximum amount of critical illness benefit that can be purchased is generally, $2,000,000.
  4. Critical Illness pays for loss due to the event you are diagnosed with one of the 24 "covered" conditions.
  5. Disability insurance pays for the loss of income due to sickness or injury.
  6. The addition of "Own Occupation" definition and "Health Care Profession Rider" adds the certainty of protection against loss if you are infective with HIV, hepatitis B or hepatitis C infection.
  7. Some existing policies can have riders added to the basic policy.

Both critical illness and disability insurance are expensive, but so is the loss of your most valuable asset - your HUMAN LIFE VALUE!

NOTE: This paper is for discussion purposes only. For specific questions, refer to contractual material provided by the insurance carrier of your choice. You are strongly advised to seek professional counsel. Not liable for errors and omissions.

 

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