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THE DENTIST DISABILITY INSURANCE CLAIM LEGAL BLOG

This blog is designed as a resource for dentists whose insurance carriers have wrongfully denied their disability insurance claims or attempted to stop paying benefits.

It is part of our firm's commitment to service to keep dental professionals (and others) apprised of industry, regulatory and legislative changes. If you would like more information about our firm or the timeliness/impact of disability insurance denials on dentists in particular, please feel free to visit our disability claim attorney website at http://www.disabilitycounsel.net/.


The 10 Biggest Legal Mistakes Dentists Make When Filing a Disability Claim (Mistake #1)

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We have been counting down the list of The 10 Biggest Legal Mistakes Dentists Make When Filing a Claim for Disability, adapted from disability insurance attorney Ed Comitz’s article, published by SEAK, Inc. (2005), and have now reached the number one mistake.

MISTAKE NO. 1:  Failing to Consult With Counsel

Dentists who are considering filing a claim for disability insurance benefits are advised to meet with an attorney experienced in the area before submitting a claim for payment.  Disability provisions vary greatly in the language used, and coverage is often circumscribed and restricted by qualifying words and phrases.  Accordingly, each insurance policy must be individually reviewed to determine whether a particular claim is covered and, if so, how that claim is best presented to ensure payment.

Action Step:  Dentists should make a coordinated effort with the assistance of an attorney when interpreting their policy, presenting their claim, and providing subsequent information to their carrier.

The disability insurance attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Scottsdale, Tucson, Flagstaff and Yuma. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.


The 10 Biggest Legal Mistakes Dentists Make When Filing a Disability Claim (Mistake #2)

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Continuing with the list of The Ten Biggest Legal Mistakes Dentists Make, as adapted from disability attorney Ed Comitz’s article, published by SEAK, Inc. (2005), is Mistake #2.

MISTAKE NO. 2:   Misunderstanding the Definitions of “Disability” and “Occupation”

Because there is no such thing as a “standard” disability insurance policy, the definitions of “disability” can significantly vary.  Most dentists purchase “own-occupation” policies, which provide compensation following a disability that prevents the insured from performing the particular duties of his or her occupation.  Thus, the insured may be entitled to benefits even if he or she could in fact perform work of a different nature.  The central issue in many cases is the definition of “total disability,” which could variously mean that the insured cannot perform “all” or “every” duty of his or her occupation, or the “substantial and material duties” of his or her occupation.  Similarly, the term “occupation” may be specifically defined in the policy (e.g., “invasive cardiologist”) or may refer to the insured’s occupation immediately prior to the time that disability benefits are sought.  In the latter situation, if the physician reduces his or her hours in the months preceding claim filing, the insurer may consider his or her occupation to be part-time rather than full-time.  Similarly, the term “occupation” may be comprised not only of the duties of a physician’s specialty, but also of significant travel time, teaching engagements, or other areas in which the physician spends time or draws revenue.  For example, “occupation” may be defined as “dentist/professor/business owner,” in which case the dentist may not be “totally disabled” if he or she can still teach or perform management functions.

Action Step:  Dentists should read and fully understand their policy terms before filing a claim for benefits.

The disability insurance attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Scottsdale, Tucson, Flagstaff and Yuma. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.


The 10 Biggest Legal Mistakes Dentists Make When Filing a Disability Claim (Mistake #3)

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Continuing with the list of the Ten Biggest Mistakes Legal Mistakes Dentists Make When Filing a Claim for Disability, is Mistake #3.

MISTAKE NO. 3:  Inadequate Documentation.

When submitting a claim and speaking with their carrier, it is important that dentists take notes to assist them in remembering what was said in the event that their claim is denied.  They should keep notes of all telephone conversations (including the date and time of the call, and what was said) and identify the person with whom they were speaking.  Every conversation with the carrier should be confirmed in a letter sent by certified mail so that there are no misunderstandings.  The “paper trail” may later be used as evidence to establish unreasonable treatment during the claim administration process.

Action Step:  Starting with their first telephone call to their insurer, physicians should document in detail their conversations and meetings, and confirm everything in writing, sent by certified mail.

The disability insurance attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Scottsdale, Tucson, Flagstaff and Yuma. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.


Don’t Toss the Policy (NOT REWRITTEN YET)

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Don’t Toss the
Policy: Important Documents for a Disability Insurance Claim

If you are a doctor, dentist, or other professional
considering filing a disability insurance claim, there are some key documents
you should collect and keep in order to properly understand and document your
claim, including:

  1. Your disability insurance policy
  2. The insurance application
  3. Notes or letters from meetings with the
    insurer’s sales agents
  4. Notes of telephone conversations with your
    insurance company employees
  5. Letters to and from your insurance company
  6. Emails to and from your insurance company
  7. Medical records
  8. Billing records from your practice
  9. A daily pain journal, if necessary

Make sure to keep all of your disability insurance papers
and notes in an organized file, and if you have to file a claim, contact an
experienced attorney who can help you interpret your policy, present your
claim, and communicate with your insurer.


The 10 Biggest Legal Mistakes Dentists Make When Filing a Disability Claim (Mistake #4)

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MISTAKE NO. 4:  Blindly Attending an Independent Medical Exam

After submitting their claim, dentists may be asked to submit to an “independent” medical examination by someone chosen and paid for by their insurer.  They may also be asked to undergo exams by someone other than a physician.  Before submitting to an independent medical exam or any other exam or evaluation, dentists must first ensure that their carrier has a right to conduct the exam per the policy language.  For example, a neuropsychological exam is conducted over several days by a psychologist, not a physician, and insurers often use the subjective findings from such an exam to deny benefits.  If the policy requires submitting only to “medical exams” or exams “conducted by a physician,” there is certainly an argument that a physician need not submit to neuropsychological testing.  Further, dentists may wish to be accompanied by an attorney or other legal or medical representatives who can monitor the independent medical exam.  Other considerations include receiving the examiner’s curriculum vitae in advance; limiting the scope of the exam to ensure that no disagnostic test that is painful, protracted, or intrustive will be performed; having the exam videotaped or audiotaped; and receiving a copy of all notes and materials generated.

Action Step:  Because the “independent” medical exam is a tool used for denying benefits where possible, dentists should work with an attorney to ensure that their rights are protected during this process.


In Today’s Uncertain Financial Environment, How Difficult Will It Be for You to Collect on Your Disability Policy?

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Attorney Ed Comitz’s article “In Today’s Uncertain Financial Environment, How Difficult Will It Be for You to Collect on Your Disability Policy?” was recently published in the July/August 2010 edition of  The Journal of Medical Practice Management.   The full article is indexed in Medline and can also be read here: How Difficult Will It Be for You to Collect.


The 10 Biggest Legal Mistakes Dentists Make When Filing a Disability Claim (Mistake #5)

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Mistake #5 in the list of The 10 Biggest Legal Mistakes Dentists Make When Filing a Claim for Disability, adapted from disability attorney Ed Comitz’s article published by SEAK, Inc., (2005) is:

MISTAKE NO. 5:  Believing All Mental Conditions Are Excluded or Subject to Limitations

Most disability insurance contracts differentiate between mental and physical disabilities.  Most recent policies cut off benefits for psychiatric conditions after two or three years.  Insureds often blindly accept their carrier’s decision to deny or limit benefits based on these conditions without considering numerous relevant factors, including whether there are any physical aspects to the mental condition, whether the mental condition has a biological/organic cause, or whether another, covered condition was the legal cause of the disability.  Without exploring these issues in detail, insureds often blindly accept that certain conditions are limited or excluded from coverage when in fact they are not.

Action Step: Dentists should understand their policy’s mental conditions limitation and work with counsel on submitting their claim in such a manner as to ensure payment of benefits.

The disability insurance attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Scottsdale, Tucson, Flagstaff and Yuma. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.


Insurers Use High-Pressure “Return to Work” Programs to Terminate Disability Insurance Benefits

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A personal return to work plan can be useful and empowering when it is the product of careful consideration between a disability insurance claimant, his doctor, and his attorney.

In the hands of an disability insurer, however, a return to work strategy is simply a means of beefing up the bottom line by pushing a claimant to give up his benefits and return to work before it’s safe.

Read the rest…


The 10 Biggest Legal Mistakes Dentists Make When Filing a Disability Claim (Mistake #6)

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[Excerpt from disability insurance attorney Edward O. Comitz’s article, The 10 Biggest Legal Mistakes Dentists Make When Filing a Claim for Disability]

MISTAKE NO. 6:  Engaging in Inadequate Communication with Treating Physician

Dentists should not discuss their claim or that they are considering filing for disability insurance benefit with their treatment provider until after they have had several visits.  Dentists are often reluctant to support claims for benefits if they question the motivations behind the claims.  A physician who has treated, without success, the dentist making the claim will likely be more willing to cooperate.  It is also important that the dentist making the claim communicate his or her symptoms and limitations to the treating physician in an organized and detailed manner so that all relevant information is recorded in the medical records, which the insurer will ultimately request.  When finally speaking to the treating physician about the claim, the dentist should ensure that the treating physician understands the definition of “disability” under the insurance policy, so that he or she can accurately opine as to the inability of the dentist making the claim to work.

Action Step:  Dentists should fully discuss their condition with their treating physician to ensure supportive medical records and, after several appointments, work with him or her on submitting the claim for “disability” as defined in the policy.


The 10 Biggest Legal Mistakes Dentists Make When Filing a Disability Claim (Mistake #7)

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Next in the list of The 10 Biggest Legal Mistakes Dentists Make When Filing a Claim for Disability, adopted from the article by disability insurance attorney Edward O. Comitz, published by SEAK, Inc. (2005):

MISTAKE NO. 7:  Quantifying Time

Dentists should be wary of insurance companies asking them to compartmentalize in percentages what activities they were engaged in pre- and postdisability.  To the extent that there is any crossover, companies will often deny benefits or provide benefits for merely a residual disability.  It is important that dentists broadly describe their important duties—rather than their incidental duties—so that the insurer has a clear understanding of the thrust of their occupation.  For example, in response to a question about principal duties and the percentage of time spent on each duty, an orthodontist may be better off stating “100% orthodontia” rather than compartmentalizing each and every incidental task (e.g., patient intake, supervising employees, follow-up visits) into discrete percentages.  The reason is the insurer may erroneously consider an incidental task a “principal duty,” and therefore downgrade the amount of benefits.  For example, where a dentist has duties as a businessman (e.g., supervising staff, overseeing payroll), the insurer may argue that the disabled dentist can still manage his or her practice and is therefore only partially disabled.

Action Step:  Dentists should not quantify their time until after they fully understand the definitions of “principal duties,” “disability,” and “occupation” under their policy.


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