Soldiering Through Misfortune by Dentaltown special projects editor John Lannon

Dentaltown Magazine

If you were severely injured, would your practice survive?

by Dentaltown special projects editor John Lannon

Dr. Richard Hoyner is tough: born-in-Chicago tough, enduring-the-winters-of-northern-Michigan tough. But earlier this year, the Arizona dentist faced a challenge that could have completely and permanently derailed his career—a fall during a hike severely injured his shoulder.

“I slid on some loose, slippery gravel. My left foot hit a rock, I turned my ankle, and I took a nosedive down the mountain, landing straight on my left shoulder,” Hoyner says. “I tried to get up three times and came close to blacking out from the pain each time. When I finally did get up, I noticed that my shoulder was down somewhere near my elbow.”

An EMT had to hike in with medical supplies to where Hoyner had fallen, and the dentist was airlifted to an emergency room, where medical staff tried to put his arm back into the socket. “They couldn’t because the bone was broken and a piece was lodged in the socket,” he recalls, “so every time they pushed the ball in there, it wouldn’t go into the cup, so to speak.” The complete diagnosis was a trifecta of debilitating traumas: His shoulder bone, the glenoid fossa, was broken; the labrum, the cartilage around the bone, had separated from it; and his rotator cuff was damaged.

“My thoughts went immediately to my career,” the 64-year-old says. “My whole left side, from my shoulder down to the tips of my fingers, felt like it was detached from me—like it wasn’t there anymore, just numb. I thought, ‘Oh, no. I don’t know too many one-armed dentists. This could be trouble.’”

Up to a half-year with no pay
The surgeon said the injury likely wouldn’t end Hoyner’s career but estimated that his lengthy recuperation and recovery could prevent him from practicing dentistry for up to half a year.

“I said, ‘Six months?! Are you kidding me, for a broken bone?’ He said, ‘You had three surgeries. You had bone repair. There are screws to hold the bone pieces together. I had to sew your cartilage back onto the bone, and then I had to do rotator cuff surgery on your shoulder. This is serious. So yes, it could be six months.’”

Hoyner’s toughness and perseverance prevailed—after thrice-weekly physical therapy he returned to work after only three months—but he still faced a significant financial challenge during the days he was unable to work.

After he moved to Arizona, Hoyner had dropped his overhead disability insurance because he no longer owned a practice, and his personal disability coverage had a 90-day waiting period.

“We were literally draining our bank account,” he says. “I know it sounds crazy, but we would have run out of money the week I went back to work, as far as what we’d saved in an emergency fund.”

Preparing for the worst
“We always advise clients to have at least six months’ liquid assets sitting in a savings account,” says Jeffrey W. Kirshner, a certified public accountant and personal financial specialist at Kirshner & Klarfeld Financial Group in Scottsdale, Arizona. “Disability insurance policies typically require a 90-day elimination period—which can be met over seven months; it doesn’t have to be consecutive 90 days, with the right policies.”
While Hoyner did have the emergency savings to cover his disability policy’s waiting period, he also came precariously close to financial despair. And he knew why: “I’m old school,” he says. “When I began practicing, we were a bit less business-savvy, and we made financial decisions differently than they do now. I’m going to say no one gave me that advice then. I’m sure some of the money that we called an ‘emergency fund’ was probably used for a new carpet in the bedroom, or maybe a new kitchen sink.”
If Hoyner’s full recovery had indeed required six months, after the first 90 days he would have been paid 40 percent of his income. “At my age, 64, I’m paying about $700 per quarter to ensure I could be paid 40 percent of my income.”

Don’t fall for these missteps!
The best disability insurance policies are designed to pay dentists “the most amount of money, in the most number of situations,” says Kirshner. “We want to protect the income that they earn in their specialties. Also, we want to have as few limitations as possible: Some carriers will look at certain health issues differently than others, and if one carrier won’t offer an exclusion for a certain issue that another company will, we prefer to go to the company that will write a clean policy without any limitations.”
Kirshner says one of the biggest mistakes practicing dentists can make is not wanting to go through the hassle of underwriting. “They’ll just avoid the concept altogether and assume that they’re going to be OK.” The other is buying a policy based on price alone: “Policies that are really inexpensive are inexpensive for a reason,” he says. “Purchase disability insurance based on the benefits, not the premiums.”

Your life—and livelihood— is on the line
“Dentists need to look at injury from two perspectives,” Hoyner says. “The financial one and the emotional one—I’ll call it the ‘people part’ of the practice, and you can’t insure that. You have to factor in where you’re at relationally. If an injury would be long term—let’s say six months to a year—I think staffers would leave, even if they’re loyal. Who can ask someone not to take a paycheck for six months? And what about your patients? They may never come back. How are you going to handle that? It’s not just the numbers and the bottom line.”
His advice to fellow dentists, especially younger ones entering the profession: “You have to have disability insurance, because not to is professional suicide. I wasn’t mountain biking, I wasn’t bungee jumping—I was hiking a trail I’ve hiked many times with friends, and I hit some loose gravel and took a nosedive down the mountain.
“I know it will be difficult to afford disability insurance when you’re starting out, but you should never be comfortable without it.”

Do You Really Need an Injury Attorney?
“When they initiate a disability claim, a lot of people are very vulnerable,” says Jeffrey W. Kirshner, a CPA and personal financial specialist at Kirshner & Klarfeld Financial Group in Scottsdale, Arizona. “It’s a very difficult time, life is changing, and they’ve perhaps heard bad stories about insurance companies denying claims, so they want to immediately hire a lawyer.”
Kirshner, however, usually recommends not doing so. “When you file a claim, everything is going to depend on medical facts, and you should give a claims department everything it asks for,” he says. “You should not embrace a confrontational approach when you first begin your claim, and attorneys generally have the reputation of being confrontational with claims departments.”
Many attorneys charge a percentage of the won benefit, Kirshner says. “If your benefit is $10,000 a month, and they take 10 percent of that, that’s $1,000 a month—and in some cases it could be for years and years.
“So if you’re adamant about hiring an attorney, hire one that bills an hourly rate. But I would only engage an attorney if the insurance company balks at approving your claim, and you feel it’s legitimate.”

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