Ed Comitz selected as an Arizona Business Leader in 2017



Ed Comitz, the head of Comitz | Beethe’s Disability Insurance and Healthcare Law practice, has been named as an Arizona Business Leader in 2017 by Arizona Business Magazine.  The 500 business leaders were selected from a pool over of 5,000 names considered.  Editor in Chief, Michael Gossie, writes of the 500 leaders selected, “They are catalysts for Arizona’s economy.  They are leaders.  They are innovators. They have influence.  And when they speak, they make things happen.”


Unum Study Shows an Increase in Musculoskeletal Disability Claims Over the Past Decade

As we have discussed in previous posts, musculoskeletal disorders are very common among dentists due to the repetitive movements and awkward static positions required to perform dental procedures. Unum, one of the largest private disability insurers in the United States, recently released statistics showing an increase in the filing of musculoskeletal disability claims over the past 10 years.

According to Unum’s internal statistics, long term disability claims related to musculoskeletal issues have risen approximately 33% over the past ten years, and long term disability claims related to joint disorders have risen approximately 22%.  In that same period of time, short term disability claims for musculoskeletal issues have increased by 14%, and short term disability claims for joint disorders have risen 26%.

This trend may lead to Unum directing a greater degree of attention towards musculoskeletal claims as the volume of these claims continues to increase.  Musculoskeletal claims are often targeted by insurance companies for denial or termination because they are easy to undercut—primarily due to the limitations of medical testing in this area.  For instance, it can be difficult to definitively link a patient’s particular subjective symptoms to specific results on an MRI, and other tests, such as EMGs, are not always reliable indicators of the symptoms that a patient is actually experiencing.  Insurers also typically conduct surveillance on individuals with neck and back problems in an effort to collect footage they can use to deny or terminate the claim.  While such footage is usually taken out of context, it can be very difficult to convince the insurance company (or a jury) to reverse a claim denial once the insurer has obtained photos or videos of activities that appear inconsistent with the insured’s disability.

As we have noted in a previous post, Unum no longer sells disability insurance policies, so its disability insurance related income is now limited to the premiums being collected on existing policies.  Because benefit denials and termination are the primary ways insurers like Unum can continue to profit from a closed block of business, and musculoskeletal claims are on the rise, Unum may begin subjecting this type of claim to even higher scrutiny.





Dealing with the Demands of Dentistry: It’s Ok to Ask for Help

Dentistry is not an easy profession.  The clinical aspects of dentistry are physically and emotionally demanding.  Performing repetitive procedures and holding static postures for prolonged periods of time can leave dentists feeling mentally drained, sore and fatigued.  And given the frequent exposure to patient anxiety and the need for precision when performing dental procedures, it is not uncommon for dentists themselves to develop anxiety about causing pain to patients or making a mistake when performing a procedure.

The other aspects of dentistry are no less challenging.  Many dentists work long hours, which makes balancing work, family, and other responsibilities difficult.  Other stressors include difficult and uncooperative patients, dissatisfied patients, finances, business problems, collecting payments, paperwork/bureaucracy, time pressure, cancellations, no-shows—the list goes on and on.  And that is not even taking into consideration major stressors, such as staff issues, board complaints, audits, and malpractice lawsuits.

When presented with these difficulties, dentists can become anxious and depressed.  Some even seek out mood altering drugs and/or begin to abuse alcohol, in an effort to alleviate the stress.

Thankfully, there are resources available where dentists can turn to for help.  Most dental associations have a subcommittee or group designed to provide confidential help to dentists struggling with emotional, mental and/or substance abuse issues.

For example, the Arizona Dental Association (AzDA) has a group called the Dentists Concerned for Dentist Committee (DCD).  The DCD is a group of fellow dentists who work with other dentists to help them with substance abuse problems, with an emphasis on “cure and return to practice.”  When the DCD is contacted, everything remains strictly confidential, and the State Board is not notified.  As explained by the DCD, “[t]here should be no grief or shame in seeking help.”  Accordingly, DCD records are “sealed and cannot be accessed by anyone.”

If you are a dentist in Arizona struggling with substance abuse, or you know a dentist who is, consider contacting the AzDA so that a referral can be made to the DCD.  You can find the contact information for the AzDA here.

If you live outside Arizona, consider contacting your local dental association to see if it has a similar program.

Remember, it’s ok to ask for help.


“When Life Feels Just Too Hard,” INSCRIPTIONS, Vol. 30, No. 8 (August 2016) at p. 24.


Orthopedic Issues Series: Degenerative Disc Disease – Part 2

In Part 1 of this post, we discussed the anatomy of the spine and some of the causes of Degenerative Disc Disease (DDD).   In Part 2 of this post, we will be discussing some of the symptoms of DDD, and some of the methods used to treat DDD.


Not all people with intervertebral disc degeneration experience pain or other symptoms.  This is due to the fact that the degeneration of the discs, by itself, does not bring on the symptoms described in the first paragraph above.  However, as disc degeneration becomes more severe, it can lead to other conditions that bring on the symptoms people normally associate with DDD (e.g., pain, numbness and tingling, weakness, etc.).  Some of the conditions commonly associated with DDD are:

  • Spinal osteoarthritis:  Sometimes referred to as spondylosis, this condition occurs when the breakdown of the cartilage and intervertebral discs leads to increased contact and irritation of the vertebrae.  It may also lead to the formation of osteophytes (abnormal bone growths) on the vertebrae that can also put pressure on nerves and contribute to the pain and nerve-related issues described above.
  • Spinal stenosis:  This condition can occur when an individual develops spondylosis. The inflammation associated with spinal osteoarthritis may cause a narrowing of the spinal canal (the hollow space in the middle of the vertebrae through which the spinal cord travels) and put pressure on the spinal cord.  This pressure on the spinal cord can cause numbness, weakness, cramping, or general pain in the arms and legs.  In some cases it can also cause bowel and bladder dysfunction.
  • Foraminal stenosis:  This condition is the result of reduced space between the vertebrae, often brought on by the degeneration of the intervertebral discs.  The reduced space may lead to increased pressure on nerve roots emerging from the spinal cord, resulting in localized pain as well as numbness, tingling, and weakness in the extremities.


Because DDD can cause such a broad range of symptoms and subsequent conditions, the treatment options vary widely.  Depending on the circumstances, treatment can range from conservative options, such as physical therapy and anti-inflammatory medications, to surgical intervention, in the form of a discectomy, laminectomy, laminoplasty, or spinal fusion.

If you are experiencing any of these symptoms, the best course of action is to consult a physician.

For more information on how disability insurers evaluate claims based on Degenerative Disc Disease, see:

A Stiff Upper Lip Can Lead to Getting Stiffed by Your Insurer

Disability Insurance: Who Gets Denied?

Myelopathy: Part 1

Myelopathy: Part 2


Orthopedic Issues Series: Degenerative Disc Disease – Part 1

This post is the first in a series we will be doing on common orthopedic issues.  In Part 1 of this post, we will discuss the anatomy of the spine and some of the causes of Degenerative Disc Disease (DDD), a common yet misunderstood spinal condition that affects a large portion of the population.   In Part 2 of this post, we will go over some of the symptoms of DDD and some of the methods for treating DDD.


There are thirty-three vertebrae in the vertebral column of the human spine, twenty-four of which articulate and move.  Between each of the vertebrae in the three articulating sections of the spine – the cervical, thoracic, and lumbar spine – there is an intervertebral disc.  Each disc, composed of soft jelly-like center (nucleus pulposus) surrounded by a capsule of connective tissue (annulus fibrosis), provides shock absorption and flexibility within the spine.  There is very little blood flow to this region of the body, and if discs are damaged or deteriorate they cannot regrow or heal themselves.


Degenerative Disc Disease (DDD) is the breakdown in the size and cushioning of the intervertebral discs, which can lead to chronic pain, weakness, numbness and tingling in extremities, and reduced flexibility in the spine. The name of the condition is actually somewhat of a misnomer – it is not actually a “disease”, but rather a condition that is characterized by the degeneration of the intervertebral discs over time. Because of this, the condition can be confusing to understand.

Reduction in the size and cushioning of your discs is part of the normal process of aging, and magnetic resonance imaging (MRI) studies have shown that almost everyone over the age of 60 has degeneration of their intervertebral discs to some degree.[1]  Not all people with disc degeneration have back pain or other symptoms – in fact, individuals with relatively mild disc degeneration may experience no symptoms whatsoever.

However, age is not the only factor in DDD.  Deterioration of the intervertebral discs can be accelerated and exacerbated by other factors.  The culprit in many severe cases of DDD is stress-related damage in the form of repetitive use, trauma, injury, poor posture, poor movement, and obesity.  Among these, one of the most common factors is repetitive use.

Medical professionals are particularly susceptible to developing DDD due to the static postures that some specialties require in clinical practice, most notably dentists.  For example, the repetitive, static posture of a dentist performing clinical procedures creates compressive forces on the cervical discs due to neck flexion and compressive forces on the lumbar discs due to axial loading (the weight of the body compressing the spine vertically).  When these compressive forces are applied for year after year on a daily basis, the result can be an accelerated deterioration of the intervertebral discs.

For more information on how disability insurers evaluate claims based on Degenerative Disc Disease, see:

A Stiff Upper Lip Can Lead to Getting Stiffed by Your Insurer

Disability Insurance: Who Gets Denied?

Myelopathy: Part 1

Myelopathy: Part 2

[1] http://www.arthritis.org/about-arthritis/types/degenerative-disc-disease/


Ed Comitz Named as Top Lawyer in Field of Insurance Law


Ed Comitz, one of the firm’s founding members, was recently named as a Top Lawyer in the field of insurance law in Phoenix Magazine’s special, 50th Anniversary Issue.

Mr. Comitz’s practice primarily focuses on helping physicians and dentists secure private disability insurance benefits.  Mr. Comitz and the legal team at Comitz | Beethe also represent doctors in several other areas, including practice transitions, employment law, business litigation, estate planning, regulatory compliance, and licensing issues.


Thinking About a Policy Buyout? How Lump Sum Settlements Work: Part 2

In this two-part series we are addressing the two most common scenarios in which insurance companies pursue lump sum buyouts.  In Part 1, we talked about buyouts for individuals who are totally and permanently disabled and have been on claim for several years.  In Part 2, we will address the other scenario in which buyouts occur: after a lawsuit has been filed.

In the context of an individual disability insurance policy, a lawsuit is generally filed in one of two common scenarios: (1) a person on claim with a legitimate disability has their benefits terminated; or, (2) a person with a legitimate disability has their claim denied.  A lawsuit is typically considered to be the last line of defense in the claims process.  By the time a lawsuit has been filed, the claimant’s attorney has likely exhausted every available means to resolve the claim without legal action.  Litigation is costly, time-consuming, and can drag on for years.

If an insurance company offers a lump sum buyout during litigation, it will typically be at one of three stages in the case: (1) after the Complaint and Answer are filed; (2) after all stages of pretrial litigation and discovery are complete; or (3) after the claimant/plaintiff wins at trial.

The first stage of any lawsuit is the filing of the Complaint.  This is a document the plaintiff files with the court outlining all of the claims and allegations against the defendant.  After receiving a copy of the Complaint, the defendant then has a specified period of time in which to file an Answer responding to the plaintiff’s allegations.

Prior to the filing of a lawsuit, a contested claim has likely been reviewed only by the insurance company’s in-house attorneys.  However, once litigation begins, the insurance company will retain a law firm experienced in insurance litigation to handle the case.  After the filing of the Complaint, the insurance company’s outside counsel will have the opportunity to evaluate the strength of the case and the claim.  Viewing the case through the prism of their experience, the insurer’s litigation team may recommend offering a buyout to avoid the risk, costs, and time associated with the lawsuit.

The second point of a lawsuit at which a buyout may occur is after all stages of pretrial litigation are complete.  Once the parties have had the opportunity to conduct discovery and litigate any pretrial motions, they will have a full picture of the case and their prospects at trial.  Through discovery both sides will be able to obtain all documents and interview all witnesses the other side intends to use at trial.  Through the filing of pretrial motions the parties can attempt to prevent or limit the use of certain evidence or witnesses at trial.

At this juncture, the insurance company may seek to avoid the risks of trial and settle the claim before the first juror is ever impaneled.  The insurance company’s incentive to resolve the case at this point – even after both sides have invested substantial resources in the litigation – is the financial exposure and bad publicity it faces with a loss at trial.  Additionally, a bad result at trial for the insurance company could create undesirable legal precedent for future cases.

If a jury (or a judge, depending on the case) determines that the insurance company has unlawfully denied or terminated a legitimate disability claim, the insurer will not only be required to pay the benefits the claimant/plaintiff is entitled to, but may also be liable for damages and other costs.  The insurer may be required to pay back benefits, plaintiff’s attorneys’ fees and costs, consequential damages, and punitive damages.

In the context of a disability insurance lawsuit, consequential damages come in the form of any financial harm to the claimant/plaintiff resulting from the insurer’s denial or termination of benefits.  For example, if the insurer’s termination of benefits led to the claimant/plaintiff losing their house in foreclosure, the insurer could be liable for consequential damages.  Punitive damages are designed to deter the insurer from denying legitimate claims in the future, and can be multiplied several times over if the insurer is found to have acted in bad faith.  Additionally, some states allow acceleration of benefits – in which the courts can order the insurer to immediately pay future benefits that would owed to the claimant/plaintiff over the full life of the policy.

The final stage at which a lump sum buyout may be offered is after a victory at trial by the claimant/plaintiff.  You may be wondering why anybody would entertain a settlement offer right after a being awarded back benefits, damages, and costs at trial – why accept anything less?  The answer is simple: appeals.  The insurance company can tie up a trial court victory in the court of appeals for years, which they can use as leverage to offer a settlement smaller than the trial award.

Though these three stages of litigation are the most common points at which a buyout may occur, buyouts themselves are uncommon during litigation.  Depending on the situation, the specter of a long, drawn out legal battle can either provide the insurance company with the incentive to settle the lawsuit early with a buyout or harden its resolve to fight the claim to the bitter end.  You cannot count on simply filing a lawsuit and expecting the insurance company to be eager to settle.  Some insurance companies want to settle early and avoid the financial risks and bad publicity of a defeat at trial, while others take a hard line and use their nearly limitless resources to fight a war of attrition.  Ultimately, whether or not an insurer offers a lump sum buyout in the midst of litigation depends largely on the individual facts of the case, the risks at trial, and the parties and attorneys involved.


Thinking About A Policy Buyout? How Lump Sum Settlements Work: Part 1

Lump sum buyouts are a frequent source of questions from our clients and potential clients. With that in mind, the next few posts will address different aspects of the buyout process.

Buyouts typically occur in one of two situations: 1) after you’ve been on claim for several years, or 2) after a lawsuit has been filed.  This blog post will focus on the first scenario.

Lump sum buyouts that occur outside of litigation normally won’t occur unless and until the insurance company decides that you are totally and permanently disabled under the policy definition.  Typically, the insurer won’t consider whether this is the case until you’ve been on claim for at least two years.  If the insurer determines that you’re totally and permanently disabled, it will then determine whether it makes sense financially for the company to offer you a percentage of your total future benefits rather than keep paying your monthly benefits for the entire duration of your claim.

To understand how the insurance company calculates whether a buyout is in its financial interest, you should understand how insurance company reserves work.  The purpose of reserves is to ensure that the insurance company has the resources to fulfill its obligations to policyholders even if the company has financial difficulties.  Thus, disability insurers are required by state regulators to keep a certain amount of money set aside, or “reserved,” to pay future claims.  Any money required to be kept in a reserve is money that the insurer can’t spend on other things or pay out in dividends.  The amounts required to be kept in the reserve are determined by the state, depending on factors like how much the monthly benefit is and how long the claim is expected to last.

For a disability insurance claim, a graph of the required reserve amount over time looks like a Bell curve: low at the beginning, highest in the middle, and low again towards the end of the benefit period.  The ideal time for a settlement, from an insurance company’s perspective, is at or just before the high middle point–typically about five to seven years into the claim, depending on the claimant’s age and the duration of the benefit period.  At this point, the company is having to set aside the highest amount of money in the reserve.

If the insurance company can pay you a percentage of your total future benefits, it can not only save money in the long run, but it can release the money in the reserve.  The insurer can then use those funds for other purposes, including providing dividends for its investors.  In addition, the insurance company will save all of the administrative expenses it was putting towards monitoring your claim.

In the next post, we’ll address how and why buyouts occur after a lawsuit has been filed.


Unum Outsourcing Jobs to India?

In past posts, we have discussed Unum’s track record of wrongfully denying disability claims and Unum’s bad faith efforts to avoid paying legitimate claims.  Unum was again in the news last year when it made significant changes within the upper echelons of company management.   Unum is now making headlines again, due to speculation that it is in the process of outsourcing hundreds of jobs overseas.

Unum is apparently currently in talks with several information technology (IT) firms to outsource up to 350 jobs to India.  A Unum employee, who spoke to the Portland Press Herald on the condition of anonymity, told the newspaper that as many as 200 jobs could be cut at Unum’s Portland, Maine offices, and estimated that the cuts could affect up to 350 jobs company-wide.  The employee reported that Unum was meeting with several vendors to discuss different levels of sourcing.  Florida attorney Sara Blackwell, who operates the website ProtectUSWorkers.com, claims that Unum has met with Cognizant and HCL – two multinational IT consulting firms – to discuss the potential move.  In an interview with the Times Free Press, Ms. Blackwell expressed concerns that policyholders’ personal medical information may be compromised by outsourcing to countries that don’t have strict provisions such as HIPAA to protect the medical records of policyholders.

It will be interesting to see if Unum’s outsourcing efforts end with its IT department, or whether this is the first step towards Unum outsourcing positions that play key roles in the disability claims process, such as claims managers and in-house medical consultants.






Should Women Pay More for Disability Insurance? Part 2

In a previous post, we discussed how a woman with the same age, job and health history as a man can end up paying an average of 25% (and in some cases, 60%) more for the same level of disability insurance protection.  We also discussed how some insurance companies raise premiums based on conditions unique to one’s sex, such as pregnancy.

When we first addressed this issue, the Massachusetts legislature was considering a bill that prohibited insurers from charging higher rates to women than to men.  At the time, Massachusetts law prohibited insurance companies from using race and religion as rating factors when determining the cost of insurance, but there was no law against using gender as a rating factor.

Recently, the Massachusetts Senate voted to approve a budget amendment adding gender to other rating factors that insurance companies are not allowed to consider when determining the cost of premiums.  The bill passed by a wide margin:  32 senators in favor of the amendment, and only 6 senators voting against the amendment.

It will be interesting to see if, in the future, other states follow suit and start to pass laws requiring insurance companies to give men and women the same premium rates for the same level of disability coverage.