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 10 - Why It Can Be a Bad Idea to Put Off Filing a Disability Claim – Part 2

7/1/2018 10:00:00 AM   |   Comments: 0   |   Views: 264

In our last post, we discussed the importance of knowing when to file a disability insurance claim, and explained that certain actions dentists take before filing can make collecting benefits more difficult or even result in the denial of a claim. In this post, we’re going to talk about a few more common mistakes dentists make when they put off filing a disability claim.

Reducing Hours Instead of Filing a Claim

Many dentists initially try to push through their disabling conditions instead of filing. This can be hard on their health, and often they are forced to reduce their practice hours as they become increasingly physically or mentally unable to maintain their former full-time schedule. This reduction could at first be only an hour a day, then whole days, and finally even weeks at a time. The hope is to rest and recover; however, if you reduce your hours for an extended period of time prior to filing, it can make things more difficult for you when you ultimately have no choice but to file.

This is because most policies define “your occupation” as what you were doing immediately prior to the onset of your disability. So, if you’re a dentist who is only working a few days a week when you ultimately file your claim, your insurer is likely going to determine that your occupation is that of a “part-time” dentist, and it is obviously much harder to prove that you are unable to work in even a part-time capacity than it is to prove you can’t practice dentistry full-time.

Some newer policies take things a step further, and say that working a set number of hours is not considered a “material duty” of your occupation, so if you have one of these newer policies, the total disability analysis will not take hours into account, and be even more procedure-focused. But under many policies, the number of hours you are working is still relevant to a total disability analysis, and it’s important to keep that in mind when assessing whether you should file a disability claim, and when you should file.

Reducing/Limiting Procedures Performed Instead of Filing a Claim

This is related to the mistake of reducing your hours prior to filing, and essentially plays out the same way.

For example, the dentist dealing with rheumatoid arthritis may start to categorically avoid and refer-out root canals and other difficult procedures and, as time goes on, may start to perform exams only, or transition into handling all of the practice’s Invisalign or sleep-dentistry services. If this change/limiting of job duties goes on long enough, this dentist will face serious hurdles when he or she decides to file a claim for the same reasons noted above in the context of reducing hours—i.e. if you stop doing certain procedures that are difficult for you and/or move into more of an administrative role before filing, you can modify your material duties and occupational definition and make it harder to collect under your policy.

Starting Another Job Before Filing

Upon realizing that you can no longer practice, you may look for another source of income and/or seek to pursue another interest by working in a new field. For example, an oral surgeon faced with a potentially career-ending medical condition may decide to pursue his or her love of art and open a small gallery. If he or she has been working in this new job long enough before filing, the insurer will argue that the oral surgeon’s “substantial and material job duties” are those of gallery owner, in addition to whatever he or she may still be doing in his capacity as an oral surgeon. Thus, transitioning to a new job prior to filing your claim can change the entire framework for your disability claim and, in some cases, make it impossible to collect total disability benefits.

Our last post in this series will examine the importance of medical diagnosis(es), treatment(s), and records in relation to filing a claim. 

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.

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