It goes
without saying that disability insurance companies would prefer not to
pay out disability claims. This is particularly true if the disability
policy is a high paying policy belonging to a dentist.
Unfortunately
for dentists, most disability policies grant the insurance company
substantial discretion to resolve factual disputes and determine benefit
eligibility. Consequently, the disability insurance claims process is
often a daunting and unpleasant experience for dentists who are
unfamiliar with how the claims process works. In many instances, a
first-time claim filer will not be able to recognize an insurer’s
tactics until it is too late.
This
series is broken down into six blog posts, and is designed to give
dentists a better sense of the various tasks and pitfalls they will face
throughout the course of the claims process.
INITIAL CLAIM FORMS: PART 1
When you first notify your insurer that you need to file a claim for
disability insurance, the insurer will send you a packet of paperwork to
complete and return. This packet will typically include Claimant’s
Statement and Occupational Questionnaire forms.
Claimant’s Statement.
This form asks you to give biographical information about yourself, such
as your date of birth, Social Security Number, and other personal
information. It will also ask you to describe your disability and
provide the names and contact information of all of your treating
physicians.
Although
many questions on the Claimant’s Statement may seem irrelevant and
overbroad, each question is there for a particular purpose. For example,
insurers commonly ask you to describe your typical day in hourly
increments from the time you awake until the time you go to sleep,
providing exact days and times. This allows them to pass your schedule
along to private investigators hired to conduct surveillance during the claim evaluation.
Claimant’s
Statements also generally contain several questions designed to elicit
answers that can be used against a claimant later on in the claims
process. For instance, you may be asked to describe how you occupy your
time, or list your hobbies. If you casually list activities that you
regularly participated in before you disability, but can no longer
engage in—for example, golf or tennis—the insurance company will assume
that you retain the capacity to perform other activities that require
similar range of movement or exertion.
Other common questions that can negatively affect your claim if answered casually or incorrectly include:
- List your principle duties and the percentage of time spent at each.
- Which duties of your occupation are you unable to perform and why?
- Which duties can you still perform and how long are you able to perform them?
- Do you own your business/are you self-employed?
- Do you have supervisory responsibilities?
While the
Claimant’s Statement may seem like an informal and unimportant
document, it is absolutely crucial that you fill out this form properly
and carefully.
Occupational Questionnaire.
Depending on the disability insurance company, this form may be part of
the Claimant’s Statement, or it may be a separate document. This form
will ask you to describe your occupation in excruciating detail. For
instance, it typically asks you to list every task and/or duty you
perform in a typical day, then to quantify what percentage of your time
is spent on each particular task/duty. It will also list several
categories of physical activity (pushing, pulling, lifting, reaching,
standing, sitting, etc.) and ask you to quantify how often your job
requires you to do them. Additionally, the occupational questionnaire
will ask for how much you get paid, a list of all of your former jobs,
and contact information for your current employer.
Because
these questions are so specific, they can be hard to answer. Most
dentists do not keep track of the percentage of time they devote to
various tasks. If you attempt to provide rough estimates or manufacture
duties in an effort to fill up all of the spaces on the form, you risk
submitting inaccurate and/or prejudicial information.
For example, some disability policies only allow you to collect if you cannot perform any of
the occupations you were engaged in immediately prior to disability. If
you provide an answer stating that you are self-employed, but fail to
specify that you are referring to your dental practice, your claim may
be delayed significantly because the insurance company believes you have
another business on the side.
Another
way you could potentially prejudice your claim is if you use absolute
language like “never” or “always” when responding to questions.
Insurance companies generally will hold you to your word, even if you
were using such language in a more colloquial sense. If you state on
your Occupational Questionnaire that you “never” leave your house, and
the insurance company’s private investigator catches you in public, your
claim will likely be denied. Once again, an experienced disability
lawyer can review your answers to ensure that they are accurate and do
not inadvertently contain statements that may prejudice your claim.
For more information on the disability insurance claims process, visit our website, www.disabilitycounsel.net or take Ed's CE, Disability Insurance Roulette: Why Is It So Hard to Collect on My Policy?
Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.