Our last post discussed a few of the
disability claim forms that will need to be filled out when you
initially file your claim. In this post, we will discuss the remaining
disability claim forms that generally must be submitted at the time you
file your claim.
INITIAL CLAIM FORMS: PART 2
Physician’s Statement.
The disability insurer will instruct you to take this form to the doctor
treating your condition and have him or her complete and sign it. This
form asks your treating provider to discuss, among other things, your
restrictions and limitations, whether he/she has advised you to stop
work, and when you are expected to improve enough to return to work.
Your treating physician’s support is
often critical to getting your claim being approved. Because a hurried,
uninterested physician may not have time to devote to your disability
insurance claim, you should find a compassionate doctor that you like
and who will spend time with you. Additionally, doctors generally do not
like hearing the phrase “disability claim” on a first visit, so you
should not discuss disability until you have tried all reasonable
treatment options and there is no improvement to your condition.
A common pitfall when filing a
disability claim is a lack of sufficient medical documentation. This
problem is even more common with dentists, because most dentists are
seeking disability due to musculoskeletal disorders that can be largely
subjective in nature. A dentist may suffer from debilitating pain, yet
the objective medical evidence (e.g. x-rays, MRIs, etc.) either fails to
reveal the injury or shows an injury that appears less severe than the
level of pain would indicate. To ensure that you have sufficient
documentation to support your claim, you should consult a physician the
moment you start experiencing symptoms and make sure that you thoroughly
explain your symptoms. That way, your treating physician can adequately
document your condition in case you need to file a claim at some point
in the future.
Another problem that disability
claimants often encounter is the insurance company contacting their
treating physicians directly without their knowledge. Insurance
companies like to have their own in-house physicians call your busy
doctors and ask them questions about your claim (this is commonly
referred to as a “peer to peer call”). The insurance company’s in-house
physician then generally prepares a “summary” of those conversations
(which may or may not be accurate) and asks your doctor to sign off
within 10 days. Usually, your treating physician will be too busy to
give the matter much thought, and may end up rubber stamping an
inaccurate “summary.” You can prevent insurance companies from abusing
peer to peer calls by asking your doctors to only answer questions that
are submitted in writing. Additionally, if you have engaged an
experienced disability attorney, your attorney can monitor the situation
and make sure that the insurer does not engage in improper
communications with your doctors.
Authorization.
Disability insurance claim authorizations are typically
quite broad. Once signed, this form allows your healthcare providers to
release any and all information about you to your insurer. It also
normally allows your insurer to discuss your claim with your doctors,
pharmacist, supervisors, employees, accountants, co-workers, friends and
family.
In connection with the Authorization,
the insurance company will also specifically request numerous records
from you. The most commonly requested records are:
- Federal and state income tax returns for the past five years;
- W-2s and 1099s for the past five years;
- Collection and production reports;
- Profit and loss statements;
- Compensation agreements;
- Practice sale agreements;
- CPT/CDT codes broken down on a monthly basis;
- List of procedures performed on a monthly basis;
- Names and addresses of malpractice insurance carriers; and
- List of all treatment providers with whom you have treated or consulted.
Most of the time, records requests ask
for information that is legitimately related to your claim. However,
they can also be quite broad and contain records that the insurance
company is not entitled to. An experienced disability lawyer can review
these types of requests and determine whether they are proper in scope.
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.