In our last several posts we have discussed how anxiety among dentists is quite common and can reach a level that may require stepping away from dentistry and filing a claim. In this final post in this series, we will be examining some of the common challenges experienced by dentists who file disability claims based on anxiety, depression and other mental health conditions.
Disability claims based on anxiety or other mental health disorders can be very difficult for the dentist filing the claim, for a number of reasons. To begin, in order to establish that you are totally disabled, you will have to provide evidence of your condition, which means that the insurance company’s doctors will be reviewing your therapy records.
While this sort of scrutiny occurs in every disability claim, in a mental health case, you’re not just dealing with personal health information as you might be in a claim filed due to a physical disability—your therapy records also often contain your most personal thoughts. Consequently, it can feel particularly invasive to have strangers read your most personal thoughts, and it can make it difficult to focus on your treatment and maintain a productive relationship with your therapist if the insurance company is second-guessing what is said or done in therapy.
In addition, insurance companies generally take the position that mental health claims are only temporary in nature and, even if they initially approve the claim, they have durational guidelines that dictate when they will revisit the claim and argue that you should have improved and returned to work. Most companies have specific claims units dedicated to these types of claims, and the insurance companies are very adept at taking advantage of any missteps made in a mental health claim, which is particularly troubling as insureds in this position are especially vulnerable.
A few of the most common tactics insurance companies use in these claims include:
Challenging the Severity of the Condition. Often insurance companies will challenge an anxiety-based claim by questioning the severity of symptoms. Unlike a claimant who suffered a severe physical injury that can be readily seen using testing like X-rays or MRIs, symptoms of anxiety are predominately self-reported. Because of this, insurance companies often take the position that a claimant is exaggerating symptoms and argue that the reported anxiety is mild and can be easily fixed by modifying the dentist’s work schedule, or by taking a vacation.
Challenging the Appropriateness of Your Care. Many newer policies have strict care provisions that can require you to not only receive regular treatment for your condition, but also require that you pursue a course of treatment designed to lead to your return to the duties of your occupation or “maximum medical improvement.” As you might imagine, in such a scenario, the insurance company’s interpretation of what is the most effective course of treatment can be vastly different from your treatment provider’s goals and recommendations.
For instance, insurers may require you to undergo a psychological examination with a provider of their choosing. Often these reports are critical of the frequency of your appointments, the medication/doses being prescribed, etc. and, in many instances, the insurance company’s provider of choice will state that more aggressive forms of therapy/treatment, like cognitive behavioral therapy (CBT), should be incorporated into your treatment plan.
Social Media. Insurers know how prevalent social media is and how everyone, including claimants, use it to share their lives with friends and family. For this reason, they often hire young people whose sole job is to check the claimants’ social media presence (including posts made by family and friends of the claimant), to see if they can find any posts or photos that they can argue are inconsistent with your reported conditions. For example, if you reported depression, along with anxiety, on your claim forms, the insurance company would try to find a picture of you smiling (say, for example, at a child’s birthday party) and then argue that this shows that you are not depressed.
Another common general tactic is the insurance company being “willfully ignorant” of the nature of your condition, how the condition impacts your ability to perform you job duties, etc. If you are not precise on claim forms, or you do not provide sufficient detail, insurers are very adept at manufacturing inconsistencies and “follow-up” questions designed to delay payment, and wear you down into abandoning your claim and/or returning to work before you are ready.
These are just a few of the tactics utilized by insurance companies in these claims. While it may seem disheartening, and these claims are certainly an uphill battle, it is possible to be successful if the claim is properly presented at the outset and monitored on an ongoing basis, to ensure that the scope of the insurance company’s investigation is proper and that the insurer continues to fairly evaluate the claim on an ongoing basis.
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.