Policy Riders: Social Insurance Substitute Rider

In prior posts we’ve talked about riders and how they can modify the terms of a disability policy.  In this post, we will be looking at a rider we sometimes see in individual disability policies called a Social Insurance Substitute (SIS) rider.

An SIS rider is an optional rider that provides a monthly benefit that works a little differently than a standard base benefit.  Generally speaking, SIS benefits can be reduced if you are eligible for and receiving social insurance benefits (e.g. Social Security retirement or disability benefits, workers’ compensation benefits, etc.).

SIS riders can operate differently, depending on the terms of your policy.  In some instances, the benefit paid by the insurer will be reduced by the amount received from social insurance (usually up to a certain amount).  In other policies, a certain percentage is subtracted from the benefits based on how many different forms of social insurance you are receiving (e.g. if you are receiving Social Security benefits, you might only receive two-thirds of your monthly benefit amount, and your monthly benefits might be further reduced if you started receiving benefits from a second source, like worker’s compensation).

The appeal of the SIS rider is that including it in a policy will typically result in a lower premium.  The logic behind this is that the insurance company shares the risk of payment with the government.  The primary downside to an SIS rider is the fact that your benefits will be reduced in some fashion if you obtain social insurance benefits.

In addition, policies with an SIS rider can also place additional requirements on policyholders by:

  • Requiring policyholders to apply for social insurance benefits;
  • Requiring policy holders to reimburse them if a lump sum payment is received from social insurance(s); and
  • Requiring policyholders to go through the entire appeals process following any social insurance denials and/or re-apply for social insurance benefits periodically.

When choosing a policy, it is important to weigh what you can afford in premiums now with potential future benefits.  If you can afford a higher premium, it is often in your best interest to choose a policy without an SIS rider and with a higher base benefit.  As we have discussed previously, there are also certain riders that you can purchase that will automatically increase your monthly benefit (and premiums) by a certain amount each year and/or allow you to apply to increase your monthly benefit in the future, without undergoing additional medical underwriting.  Whether you are shopping for a policy, or evaluating your existing policy, you should always keep in mind that the cost of the premium is not the only consideration.  There are other factors in play that you must consider when purchasing a policy, and the type of insurance that you purchase can have a significant impact upon your financial position if you should become disabled.

Migraine Headaches

Migraine headaches can be debilitating, and, in some cases, chronic.  In this post, we will look at some of the symptoms of migraines, how they are diagnosed, and some common treatments for migraines.

Overview

Migraines are characterized by severe headaches that usually involve throbbing pain felt on one side of the head, and can be accompanied by symptoms such as nausea, vomiting, and/or sensitivity to light and sound.

Migraines are the third most prevalent illness in the world, and can interfere with an individual’s ability to work and complete day-to-day activities, especially for those suffering from chronic migraines.  Some studies have determined that healthcare and lost productivity costs associated with migraines may be as high as $36 billion annually.  Migraines can affect anyone—in the U.S. 18% of migraine sufferers are women, 6% are men, and 10% are children.  They are more common in individuals aged 25 to 55 and in those with family members that also suffer from migraines.[1]

Symptoms

Migraine symptoms, frequency, and length vary from person to person.  However, they usually have four stages:

Prodrome: This occurs one or two days before a migraine attack and can include mood changes, food cravings, neck stiffness, frequent yawning, increased thirst and urination, and constipation.

Aura: This stage can occur before or during a migraine attack.  Auras are usually  visual disturbances (flashes of light, wavy or zigzag vision, seeing spots or other shapes, or vision loss.  There can also be sensory (pins and needles, numbness or weakness on one side of the body, hearing noises), motor (jerking), or speech (difficulty speaking) disturbances.  While auras often occur 10 to 15 minutes before a headache, they can occur anywhere from a day to a few minutes before a migraine attack.  Typically, an aura goes away after the migraine attack, but in some cases, it lasts for a week or more afterwards (this is called persistent aura without infarction).

Migraine: The migraine itself consists of some or all of the following symptoms:

  • Pain on one or both sides of the head that often begins as a dull pain but becomes throbbing
  • Sensitivity to light, sound, odors, or sensations
  • Nausea and vomiting
  • Blurred vision
  • Dizziness and/or fainting
  • Migrainous stroke or migrainous infraction (in rare cases)

Post-drome: This stage follows a migraine and can include confusion, mental dullness, dizziness,  neck pain, and the need for more sleep.

A migraine can last anywhere from a few hours to several days, and there are several classifications of migraines, including:

  • Classic migraine – migraine with aura
  • Common migraine – migraine without aura
  • Chronic migraine – a headache occurring at least 15 days per month, for at least three months,
    eight of which have features of a migraine
  • Status migraine – (status migrainosus) a severe migraine attack that lasts for longer than 3 days

Causes

The exact causes of migraines are not clearly understood but involve abnormal brain activity, including (1) changes in the brain stem and its interactions with the trigeminal nerve and (2) imbalances in brain chemicals, including serotonin.  Migraines are most often triggered by:

  • Food and food additives (often salty or aged food, MSG, meats with nitrites, aspartame)
  • Skipping meals
  • Drink (alcohol, caffeine, caffeine withdrawal)
  • Sensory stimuli (bright or flashing lights, strong odors, loud noises)
  • Hormonal changes or hormone medication such as birth control
  • Certain other medications
  • Stress or anxiety
  • Strenuous exercise or other physical stress
  • Change in sleep patterns
  • Changes in weather

Co-occurrence

Migraines have been shown to co-occur with several other conditions[2], including:

Treatment

There are a variety of options that doctors employ to both treat and prevent migraine attacks.

  • Pain-relieving medications (both over the counter and prescription)
  • Preventative medications (which can include antidepressants, blood pressure
    medications, and seizure medications)
  • Botox
  • Transcutaneous supraorbital nerve stimulation (t-SNS)
    (a headband-like device with attached electrodes)
  • Acupuncture
  • Biofeedback
  • Massage therapy
  • Cognitive behavioral therapy (CBT)
  • Herbs, vitamins, and minerals
  • Relaxation exercises
  • Sticking to a sleep schedule
  • Exercise
  • Avoidance of known triggers

Doctors also sometimes recommend keeping a headache diary, similar to a pain journal, which can help you track the frequency of your migraines and may help identify triggers.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional.  If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose.  Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References:

Cedars-Sinai, https://www.cedars-sinai.edu
Healthline, www.healthline.com
Mayo Clinic, www.mayoclinic.org
MedlinePlus, www.medlineplus.gov
[1] Migraine Research Foundation, About Migraine, http://migraineresearchfoundation.org/about-migraine/migraine-facts/
[2] Wang, Shuu-Jiun, et. al., Comorbidities of Migraine, Frontiers in Neurology, Aug. 23, 2010, http://journal.frontiersin.org/article/10.3389/fneur.2010.00016/full
[3] Id. (citing Von Korff M., et. al., Chronic spinal pain and physical-mental comorbidity in the United States: results from the national comorbidity survey replication, Pain 113, 331-330 (2005).

“Transitional Own Occupation” Provisions

In prior posts, we’ve talked before about how an individual disability policy with a true “own occupation” provision is ideal.   Under this type of provision, you are “totally disabled” if you are no longer able to perform the material and substantial duties of your occupation (for example, you can no longer perform dentistry), and you can still work in a different field and receive your full benefits (if you are able and choose to do so).

Most doctors looking for a disability policy know that it’s important to get an “own occupation” policy, but may not realize that there are several, less-favorable provisions that are also styled as “own occupation” provisions.  These provisions contain the phrase “own occupation,” but also contain language that can dramatically impact a doctor’s ability to collect.  For example, a policy might provide benefits if you are no longer able to work in your occupation, but only if you are not working in any other occupation.   And some newer disability policies actually require you to work in another occupation in order to collect benefits.

Another type of restriction we’ve been seeing recently is a “transitional own occupation” or “transitional your occupation” policy.  As we stated above, under the true “own-occupation” policies prevalent in the 80’s and 90’s, you can work in another profession and still collect full benefits, regardless of whether you make less, the same, or more than when you were practicing.  With “transitional own occupation policies”  or “transitional your occupation policies,” you can work in another profession, but your benefits are reduced if your total income (from your benefits, employment, and other insurance benefits) ever exceeds what you made immediately prior to your disability.  So, with these types of policies, your earning potential is essentially capped at what you were making before you became disabled (if you want to keep receiving benefits under your policy).

Transitional own occupation policies may seem attractive because they may have lower premiums, but it is important to know that they are not the same as true “own occupation” policies, and they can result in a reduced benefit payment and/or limit your options if a lucrative employment opportunity should ever arise.

While many policies contain the phrase “own-occupation,” including “transitional own occupation” provisions, they often aren’t true own-occupation policies and you shouldn’t rely on an insurance agent to disclose this information.  Oftentimes, your agent may not even realize all of the ramifications of the language and definitions in the policy that he/she is selling to you. Additionally, most of the newer disability policies now contain language saying that you cannot rely on an agent’s statements and/or that agents cannot change the terms of a policy.  Consequently, you should always read a policy from start to finish and make sure you have a clear understanding of what you are buying, before purchasing a disability policy.

Spine-Related Musculoskeletal Conditions – Part 7 – Myelopathy

In this series, we have been reviewing spine-related musculoskeletal conditions that are frequently seen in dentists and surgeons.  In this post, we will be looking at myelopathy.

Myelopathy

Definition: Myelopathy is damage to the spinal cord caused either by a traumatic injury or a chronic musculoskeletal condition. The term myelopathy generally refers to damage to the spinal cord, but may be used in reference to a handful of specific conditions, including:

Cervical Spondylotic Myelopathy: This is by far the most common form of myelopathy and involves the compression of the spinal cord in the cervical spine (neck). We will discuss cervical spondylotic myelopathy further below.

Thoracic Myelopathy: This occurs in the middle region of the spine. Typically, the spine gets compressed due to bulging or herniated discs, bone spurs, or spinal trauma.

Lumbar Myelopathy: This is a rare condition because the spinal cord typically ends in the upper section of the lumbar spine; however, the if the spinal cord is low-lying or tethered, it can be affected by this condition.

Cervical Spondylotic Myelopathy

Overview:  Cervical spondylotic myelopathy is damage to the spinal cord due to spinal degeneration, most commonly in the form of spinal osteoarthritis. As the spinal cord is compressed (spinal stenosis) due to inflammation and osteophytes, it can cause damage to the spinal cord and lead to an array of neurological symptoms.

Causes:  As discussed above, the inflammation and bone spurs (osteophytes) common to spinal osteoarthritis can exert pressure on the spinal cord and cause damage.  Bulging and herniated discs and thickened ligaments can also contribute to myelopathy.  In rarer cases an acute, traumatic injury to the neck can result in myelopathy.

Symptoms:  Numbness, weakness, and/or tingling in the hands or arms, loss of balance, stiffness in the legs, and urinary urgency.

Diagnosis: A CT scan with a Myelogram is used to reveal indentations in the spinal fluid sac.  In this procedure an opaque dye is injected into the spinal canal prior to the CT scan to create contrast and provide images of the spinal canal.  This is done in conjunction with an MRI, which provides imaging of the spinal cord and nerve roots, as well as the intervertebral discs and spinal ligaments.

Treatment: Surgery to decompress the spinal cord and prevent further damage is the most common treatment for cervical spondylotic myelopathy.  The precise nature of the surgery varies and depends on the severity of the condition and its location.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional.  If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose.  Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References:

1. Spine-health, https://www.spine-health.com/.
2. Mayo Clinic, http://www.mayoclinic.org/.
3. The Neurological Institute of New York,
http://columbianeurology.org/about-us/neurological-institute-new-york.
4. John Hopkins Medicine, http://www.hopkinsmedicine.org/.
5. WebMD, http://www.webmd.com/.