Our last post discussed what you need to
do to keep your disability benefits once they have been awarded.
Unfortunately, many dentists’ claims are denied, particularly in the
early stages of the claims process. Insurance companies will also
periodically attempt to terminate dentists’ disability benefits after
consistently paying benefits for several years. In our final post, we
discuss what you should do if your disability benefits are denied or
terminated.
WHAT HAPPENS IF YOUR DISABILITY BENEFITS ARE DENIED/TERMINATED
Receiving notice of denial or
termination can be a frustrating and disheartening experience.
Unfortunately, during this emotional time, many dentists inadvertently
take actions that prejudice their claims. With that in mind, it’s
important to review what to do and what not to do in the first few days
after your claim is denied or terminated.
Delay and Attrition
First, you should take a step back and remind yourself that disability
insurance companies often try to wear you down by drawing out the
disability claims process for as long as possible. For instance, they
ask for records, you provide them, they say the records are insufficient
and ask for more, etc. These delays can be frustrating, as they can
keep you from getting your benefits and you need them because you can’t
work. In some instances, disability insurers may deny your initial claim
in the hopes that you will simply give up, but if pressed, they may
reverse the denial on appeal. An experienced disability lawyer can help
you assess the merits of your claim and determine whether you should
appeal.
Additionally, remember that insurers
have a duty to make prompt decisions, so you should not have to tolerate
undue delays. A disability attorney can also help you deal with
insurers who are improperly using delay tactics against you.
The Denial/Termination Call
In all likelihood, you will first find out that your insurer is denying
or ending your disability benefits via a telephone call from the claims
consultant who analyzed your claim. As we explained in previous posts,
claims consultants will be taking detailed notes about anything you say
during that call. Therefore, even if you are justifiably upset or angry,
be very mindful of what you say. Anything you tell the consultant will
certainly be written down and saved in your file. Be sure to make your
own notes during the call with your consultant. You do not need to ask a
lot of questions at this stage, but you do want to make sure to record
whatever information the consultant gives you.
The Denial/Termination Letter
Following the phone call, you should receive a letter from the insurance
company stating that it has denied your claim or discontinued your
benefit payments. According to most state and federal law, the letter
should have a detailed explanation of the evidence the company reviewed
and why the insurer thinks that evidence shows you aren’t entitled to
benefits. When you receive the letter, read through it carefully. Make
notes on a separate document about any inaccuracies you identify.
Make sure you keep a copy of the denial
or termination letter as well as the envelope it came in. You should
also make a note of the date on which you received the letter. The date
the letter was actually mailed and received could be important to your
legal rights in the future. Then, the best thing to do is to scan the
documents electronically or make a photocopy for your file, just in case
the original denial letter gets lost or damaged.
The Appeal
Once you find out that your claim has been denied or terminated, you
should contact a disability insurance attorney. Some doctors and
dentists attempt to handle an appeal of their claim on their own, but we
strongly suggest at least consulting with a law firm. Every insurance
company has its own team of highly-trained claims analysts, in-house
doctors, and specialized insurance lawyers to help it support the denial
of your claim. Having your own counsel can level the playing field by
making sure you know your rights under your policy and what leverage the
applicable law provides you, and help you avoid the common traps that
insurance companies lay for claimants on appeal.
Whatever disability insurance attorney
you choose to contact, make sure you do so as soon as possible. In many
circumstances, you will only have a limited amount of time to appeal the
insurance company’s decision. Particularly in claims governed by the
federal law ERISA, the clock starts ticking as soon as you find out your
claim has been denied or terminated.
It’s usually best to contact a
disability lawyer before you respond to the denial letter, to avoid
saying anything that could prejudice your appeal. For instance, if you
have a policy that is governed by ERISA, and you submit some additional
information, the insurance company may not allow you to submit any
additional information after your initial response.
Before you meet with potential
disability insurance lawyers, gather whatever documents you can to help
them evaluate the status of your claim. Relevant documents include your
insurance policy or policies, medical records and any correspondence
between you and your insurance company. If you are not able to locate
this information, it could cause delays in starting the appeal process.
Do Not Try to Return to Work If You Are Disabled
If you are a dentist who is totally disabled, you should not try to go
back to work just because your insurance company thinks you don’t
qualify for benefits. Trying to practice when you lack the physical or
mental capacity to do so could cause you to re-injure yourself or
accidentally harm your patients. Of course, trying to work on patients
after you’ve claimed that you are totally disabled can expose you to
professional liability as well. Lastly, trying to return to work could
impair your ability to collect your benefits upon appeal.
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.