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 11 - Why It Can Be a Bad Idea to Put Off Filing a Disability Claim – Part 3

8/1/2018 10:00:00 AM   |   Comments: 0   |   Views: 297

In our last two posts, 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 final post in this series, we will examine some important details many dentists overlook when filing a disability claim.

Failing to Properly Document a Medical Condition Prior to Filing

Many of our clients have conditions that are chronic and degenerative. Oftentimes, dentists suffering from these sorts of conditions decide there’s no point in continuing to see their doctors, because there’s nothing that can be done to cure the condition.

The problem here is that, if you file a claim, you will need to have an established relationship with a treating doctor who can fill out claim forms and answer your insurer’s questions regarding the limitations of your condition. Additionally, if you go extended periods of time without seeing a doctor before permanency has been established, you are opening the door for your insurer to come in and question the severity of your condition, trivialize your limitations and “assume” that they no longer exist, because they are not being documented in any medical records.

Accordingly, it is important to consider the nature of your condition, and make sure that your condition is accurately and sufficiently documented in medical records before filing a claim.

Continuing to Work In Spite of Significant Test Results/Surgery Recommendations 

This is a fairly common phenomenon, as many dentists don’t want to face the prospect of being unable to practice and/or feel that they are too busy to take any time away for a surgery. However, once your doctor tells you that things are heading in this direction, it’s important that you make a decision regarding whether you are going to file a claim.

If you ignore the test results/surgery recommendation and continue to practice, you not only open yourself up to malpractice liability, but also can make it more difficult to collect if you file a claim later on. When you ultimately file your claim, your insurer will invariably request your medical records, and if you have significant test findings, they will seize upon them and hold them out as evidence that you can continue to practice in spite of your condition (because you demonstrated an ability to continue working in spite of the test results).

In instances like these, it becomes difficult to prove the condition is actually disabling unless a new test result can show that you are significantly worse-off than you were when the initial test was performed. At best, you will be left with a partial/residual claim and, at worst, your claim could be denied altogether.

Riding the “Carousel of Treatment”

Conditions common to dentists are often chronic and progressive, with symptoms that are often subjective and not easily diagnosed. For example, with musculoskeletal conditions such as degenerative disc disease, an MRI might not show the exact point of nerve impingement and won’t be able to measure the degree that the degeneration may be contributing to symptoms like pain levels and numbness (particularly if there may be other contributing factors, like carpal tunnel). 

Dentists dealing with these types of degenerative conditions often visit multiple doctors, specialists, and other providers in a variety of fields, and undergo countless tests in an attempt to obtain a diagnosis and relief (what we call “the carousel of treatment”). In some instances, this searching can go on for several months to a year, or longer. Meanwhile, the dentist cannot practice 100% (if at all), but at the same time feels he or she can’t file until there is a definitive diagnosis.

While having a concrete diagnosis will certainly help support a claim, continuing to wait too long can lead to a denial, in part because (as noted above) working part-time may change the definition of job duties under a policy and opens the door for the insurance company to argue that you have demonstrated an ability to work in spite of your symptoms. Consequently, if you feel like you are stuck on this “carousel of treatment,” it’s a good idea to speak with an experienced disability attorney, to make sure that you are moving forward with purpose, and you don’t stay on the carousel too long and file an untimely claim.

The Takeaway

In this series, we have only discussed a few of the considerations that go into the timing of filing a disability claim, and there may be other considerations depending on your particular circumstances. For example, if you own your practice, you will have to decide when/if you are going to sell the practice and have a plan for that aspect of the transition as well.

A disability claim has a lot of moving parts, and timing is important to ensure that a claim is and remains successful. Too often we hear from clients who have had their claims denied or only receive residual/partial benefits because they did not time their claim correctly. And, while it is sometimes possible to mitigate these mistakes, doing so can require costly litigation that can run for years before you receive any benefits. So it is much better to do things correctly from the start.

In sum, if you think you need to file a claim, you should, at a minimum, learn about how the claims process works, consult with a disability attorney, and put together a comprehensive plan for your transition out of practice before you submit any claim forms to the insurance company.

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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