Disability Claim Tips With Ed Comitz, Esq.
Disability Claim Tips With Ed Comitz, Esq.
This guide is intended as a practical resource for dentists who think they might want to file a disability claim. Check in regularly for new claim tips.
Edward Comitz

Claim Tip 1: Do You Need a Disability Insurance Policy?

10/1/2017 9:00:00 AM   |   Comments: 0   |   Views: 391
If you’re a practicing dentist, the answer is a resounding yes, as there’s a high likelihood that you’ll have to file a disability claim at some point in your career.  Studies have shown that a majority of dental students experience chronic musculoskeletal pain by their third year of dental school, and this number only increases as they become full-time dentists.1   Three out of four dentists suffer from musculoskeletal disorders that affect their ability to practice,2  and similar studies estimate the percentage of dental professionals suffering from general pain in the back, neck, shoulder, or arm is as high as 81%.3

This is not surprising, when you consider the unique demands of the profession: 

• Prolonged static posture;

• Constant forward bending;

• Repeated rotation of the head, neck, and trunk to one side;

• Holding the head forward to work in front of and below eye level;

• Repetitive motions;

• Forceful exertions;

• Mechanical stress;

• Vibrating instruments; and

• Restrictive ambidextrous gloves.

Additionally, unlike other surgical professions, most dentists don’t have a “surgery day,” after which they’re able to let their body rest and recover while consulting with patients in a non-surgical capacity.  For most dentists, every day is “surgery day,” and neck and back pain is just an occupational hazard that comes with the territory. 

Unfortunately, these types of conditions result in nearly half of all dentists having to shorten their work hours at some point during their career.4   And, because these conditions are progressive in nature, many dentists are ultimately forced to leave the profession permanently, for the sake of their own health and the safety of their patients.

If/when you find yourself in this position, it is critical that you have a disability plan in place to replace your lost income.  Depending on the terms of your policy, you may be able to transition into another job (if your policy has a “true own occupation” provision), but many policies have strict “no work” requirements that prevent you from working and collecting benefits.  Either way, collecting your benefits will likely be critical to meeting your expenses and maintaining your standard of living, if you’re no longer able to work as a dentist.

Many dentists believe that, so long as they have a supportive doctor, they’ll just submit their claim, have their doctor sign a form, and start receiving their monthly benefit checks.  But a disability claim is much more involved than that.  The initial claims investigation typically takes several months, and there is a long list of documentation that the insurance company can require you to submit, including detailed claims packets full of trick questions, your medical records, your financial records, and your CDT codes, among other things.  The insurance company can also require you to submit to interviews (both over the phone and in-person), medical exams (with doctors of their choosing), vocational assessments (to see if there’s any workplace modifications that would allow you to go back to work), and several other types of exams, depending on the nature of your condition.

While all of these investigation tools cost the insurance company money, the amount they spend on investigations pales in comparison to the amount that they would be obligated to pay if your claim is successful—particularly if you are still young, or have lifetime benefits.  Most dentists, if they are not underinsured, have high-paying policies and, as a result, their claims are subjected to close scrutiny.  As a dentist, you’ve probably been in disputes with insurance companies over amounts that are (comparatively) insignificant, and you may have even given up and determined that the money is not worth the stress.  Insurance companies use these same tactics of attrition in disability claims, only on a much larger scale.  They know that if they make the claims process drawn out and stressful and/or force policyholders to go to court to collect their benefits, that many policyholders will just give up and determine it’s not worth the hassle.  Ultimately, you’re dealing with a company, not a person, and in the end, it just comes down to math—are you going to be a liability for them, or can they force you back to paying premiums, so that you remain an asset?

While it can be disheartening to come to this realization, you still have a contract with the insurance company, and they still have an obligation to pay you benefits if you satisfy the requirements under your policy.  So how do you go up against an insurance company with vast resources and years of experience targeting and denying claims?  The first step is learning how the claims process works, and what to expect if you file a claim.  In this blog, we’ll be sharing claim tips and insight into the tactics that insurance companies use to deny dentists’ claims, in an effort to help dentists become more educated about some of the challenges they may face if they end up needing to file a disability claim.

In our next post, we’ll explain why dentists’ claims are often targeted for denial and easy for the insurance company to undercut.

Information offered purely for general informational purposes and not intended to create an attorney-client relationship.  Anyone reading this post should not act on any information contained herein without seeking professional counsel from an attorney.

1 Kristina Lynch, My back is hurting my practice, Part I, AGD Impact, Feb. 2006.
2Id.
3
Id.
4. Curt Hammann, et al., Prevalence of carpal tunnel syndrome and median mononeuropathy amount dentists, JADA, February 2001, at 163.
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