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Ed Comitz Selected as one of Arizona’s Top 100 Lawyers by Az Business Magazine

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Top 100 Lawyers - Az BusinessTop 100 Lawyers - EOC

Attorney Ed Comitz, the head of the healthcare and disability insurance practice at Comitz | Beethe, was chosen by Az Business as one of the Top 100 Lawyers in Arizona. Attorneys throughout the state were nominated by their firms and their peers.  From that pool of over 1,000 attorneys, the editorial team and industry experts narrowed down the list to the 100 top lawyers in the state based upon their professional success, impact on the firm, impact on the community and impact on the legal profession.


Disability Buyout Policies

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Have you ever wondered about disability buyout insurance for doctors and dentists?

Attorney Patrick T. Stanley gives a comprehensive overview of these policies on Comitz Beethe’s healthcare transactions and litigation blog.

Check it out and contact Mr. Stanley with your questions: Disability Buyout Insurance–Protecting Yourself and Your Partners.

Disability Insurer Profiles: Northwestern Mutual

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In this series, we’re taking a look at some of the most popular disability insurance companies for doctors.  See our profiles of MassMutual and MetLife.  Northwestern Mutual is another disability insurer that specifically markets its policies to physicians and dentists.

In 2014, the  company insured 476,000 people through 727,000 individual disability policies. Northwestern Mutual prides itself on paying more dividends that its competitors.  In order to do that, of  course, it must maintain consistently high profit levels.

Company: Northwestern Mutual Life Insurance Company.

Location: Milwaukee, Wisconsin.

Associated Entities: Northwestern Long Term Care Insurance Co., Northwestern Mutual Investment Services, LLC, Northwestern Mutual Wealth Management Co., The Frank Russell Co.

Assets: $217.1 billion in 2014.

Notable Policy Features:  Northwestern Mutual sells policies with an “own occupation” definition of total disability.  However, these policies are often only truly “own occupation” for a limited amount of time, after which they become any occupation policies (only providing benefits if you are unable to work in any job) or “no work” own occupation policies (only providing benefits if you are unable to perform your job duties and are not working in another job).

For instance, a Northwestern Mutual policy might include the following definition:

Total Disability. Until the end of the Initial Period [defined elsewhere as 60 months of benefits], the Insured is totally disabled when is unable to perform the principal duties of his occupation.  After the Initial Period [i.e., 60 months], the Insured is totally disabled when he is unable to perform the principal duties of his occupation and is not gainfully employed in any occupation.

In order to make sure a Northwestern Mutual disability insurance policy keeps the own occupation definition for as long as you hold the policy, you may need to purchase an additional benefit rider.

Read more about Northwestern Mutual’s interpretation of its own occupation policies.

Claims Management Approach: Some of the claims strategies that Northwestern Mutual is known to use include conducting in-home field interviews on top of third-party surveillance, hiring its own medical consultants to review claimants’ records and opine on whether or not they are disabled, and demanding that claimants (especially those with mental conditions) undergo “independent” medical examinations (IMEs) with providers of Northwestern Mutual’s choosing.


These profiles are based on our opinions and experience. Additional source(s): Northwestern Mutual’s 2013 Annual Report; Northwestern Mutual Fact Sheet 2014;

Disability Insurer Profiles: MetLife

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Today we’re profiling another popular insurer that issues private disability policies to dentists and physicians: MetLife.

Company: Metropolitan Life Insurance Company, a.k.a. MetLife.

Location: New York, NY.

Associated Entities: MetLife, Inc. (parent company), General American Life Insurance Company, New England Life Insurance Company.

Assets: MetLife, Inc. held over $885 billion in assets as of May 2014, according to Forbes.

Notable Policy Features:  One thing to watch out for in MetLife policies is a limitation on benefits for mental disorders and/or substance use disorder.  Under the Limited Monthly Disorders and/or Substance Use Disorders provision of some MetLife policies, policyholders are only entitled to a total of 24 months of benefits for any mental or substance abuse disorder, such as depression, panic disorder, post-traumatic stress disorder (PTSD), bipolar disorder, and alcohol abuse or dependency.  The 24 month limitation is cumulative.  So, for example, if you have depression that disables you for 23 months, then start suffering from disabling alcohol dependency later in your life, you would only have one month of benefits still available to you.

Claims Management Approach: In its 2013 Annual Report, MetLife, Inc. reported that “unfavorable morbidity experience in our individual income disability business resulted in a $6 million decrease in operating earnings.”  In other words, in 2013, more private disability insurance policyholders experienced disabling illnesses or injuries than in years before, and that hurt MetLife’s profits.  In these situations, where an insurer is facing increased liability for benefit payments, we often see that insurer put additional resources towards managing claims.  In this way, the insurer can spend extra time and effort looking for ways to deny or terminate claims, with the goal of limiting its liability.

In our experience, one way that MetLife attempts to dispose of claims as quickly as possible is by ordering surveillance early on in the claim.  While some companies will wait until they have received more information before starting surveillance, MetLife has started following and videotaping claimants within weeks of the claim being filed.

With respect to its medical investigation, we have found that MetLife often follows a similar strategy to MassMutual’s.  The insurer will often attempt to have its own medical personnel schedule “peer-to-peer” telephone consultations with claimants’ treating physicians, with the aim of catching the treating physician off guard and persuading them into saying their patient isn’t disabled.  However, we have found that, in certain circumstances, MetLife can be amenable to submitting medical questions to the treating doctor in writing instead.  That way, the treating doctor can more carefully consider the issues, without feeling pressured or put on the spot.


These profiles are based on our opinions and experience. Additional source(s): MetLife’s 2013 Annual Report;

Disability Insurer Profiles: MassMutual

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We have written about Unum, arguably the most notorious disability insurance company, in great detail.  However, we realize that many physicians and dentists may not know very much about other disability insurance companies, including those whose policies they own.  In the next few posts, we’ll profile some of the most common doctors’ disability insurers.

Company: Massachusetts Mutual Life Insurance Company, a.k.a. MassMutual.

Location: Springfield, Massachusetts.

Associated Entities: Mass Mutual Financial Group (parent  company), C.M. Life Insurance Company, MML Bay State Life Insurance Company.

Assets: Over $195 billion in 2013.

Notable Policy Features:  As part of its product offerings, MassMutual sells own-occupation disability insurance policies to physicians and dentists.  One notable aspect of some MassMutual policies we’ve seen recently is an especially restrictive definition of “Total Disability,” which we sometimes refer to as a “no work” own-occupation definition.  Under the “no work” own-occupation definition, an insured is Totally Disabled if he or she is unable to perform the material and substantial duties of his or her own occupation and not working in any occupation.  Unlike traditional own-occupation policies that allow a physician or dentist to collect total disability benefits and return to work in a different occupation, this one will not pay total disability benefits if the policyholder is doing any type of gainful work.

Claims Management Approach: MassMutual is a highly successful insurer.  In June 2014, it was ranked number 96 in the Fortune 500.  However, Fortune reports that MassMutual is currently experiencing a dramatic reduction in profits.  If MassMutual follows the current trends in the disability insurance industry, we believe it will increase scrutiny on disability insurance claims in order to try to regain its former profit levels.

In our experience, one of the ways MassMutual aggressively approaches claims is to hire a medical consultant to evaluate claimants’ medical records.  The consultant then tries to insert himself or herself between the claimant and the treating physician, writing or calling the treating physician and suggesting treatment methods that, in the consultant’s opinion, will get the claimant back to work as soon as possible.


These profiles are based on our opinions and experience. Additional source(s): MassMutual’s 2013 Annual Report; Fortune 500 2014;

Legal Requirements for Denial Letters: What Your Insurance Company Has to Tell You When It Denies or Terminates Your Claim

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stack of letters

If your claim for disability insurance benefits is denied or terminated (i.e., if the insurance company discontinues benefits they were once paying), the insurance company will send you a letter notifying you of that denial or termination.  Depending on the state you live in and the type of policy you have, the insurance company’s denial or termination letter has to include certain information.  Most doctors have individual (a.k.a. private) disability insurance policies governed by state law.  Below are some examples of denial letter requirements in several states.

Arizona: Under Arizona law, the denial letter should reference any specific policy provision, condition, or exclusion upon which the denial or termination was based.[1]  The letter should also provide a reasonable explanation why, given the facts of your claim and/or the applicable law, the insurer believes you do not qualify for benefits under the terms of your particular policy.[2]

California: In California, insurers must advise claimants of the acceptance or denial of a claim within 40 calendar days of receipt of proof of claim, unless they provide written notice of a need for additional time within that 40 days.[3]  All denials must be in writing (as opposed to simply given over the telephone), and the denial or termination letter must state reasons for the decision, including reference to specific policy provisions.[4]  Like in Arizona, denial or termination letters from California disability insurance companies should provide a reasonable explanation of the basis the insurer relied on in the insurance policy, in relation to the facts or applicable law, for the denial.[5]

Nevada: Nevada disability insurers have 30 working days after receiving properly executed proofs of loss to advise claimants of the acceptance or denial of the claim, unless the insurer advises otherwise within the 30-day period.[6]  Nevada law requires that denials be in writing, and it must include whatever specific policy provision, condition or exclusion upon which the insurer based its decision.[7]  Just like Arizona and California, Nevada law indicates that disability insurance denial letters should provide a reasonable explanation of the basis the insurer relied on in the insurance policy, in relation to the facts or applicable law, for the denial of the claim.[8]

Utah:  Utah follows the same 30-day rule as Nevada with respect to the time the insurer has to provide a claims determination.  In Utah, the insurance company must not only put the basis for the denial or termination of the claim in a letter to the claimant, it must also record that basis in its claim file.[9]  Consistent with the other states mentioned, insurers are prohibited from denying a claim on the grounds of a specific provision, condition, or exclusion in the policy unless they reference that provision, condition or exclusion in the denial letter.[10]

We always recommend contacting a disability insurance attorney if your claim is denied or terminated.  If your denial or termination letter does not include the required information, be sure to let the attorney know, as you may have additional legal rights that you need to enforce.

[1] R20-6-801(G)(1)(a).

[2] A.R.S. § 20-461(15).

[3] Cal. Code Regs. tit. 10, § 2695.7(b).

[4] Cal. Code. Regs. tit. 10 § 2695.7(b)(1).

[5] Cal. Ins. Code § 790.03(h)(13).

[6] Nev. Admin. Code ch. 686A.675(1), (3).

[7] Nev. Admin. Code ch. 686A.675(1).

[8] N.R.S. § 686A.310(1)(n).

[9] Utah Admin. Code. R590-190-10(2).

[10] Id.

Edward Comitz Named as an Arizona Business Leader in Healthcare Law

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AzBusiness Leaders 2015 - cover - compressedAzBusiness Leaders 2015 - Healthcare Law page - ED ONLY3

Edward O. Comitz, the head of the healthcare and disability insurance law practice at the Scottsdale law firm of Comitz | Beethe, has been selected as an Arizona Business Leader in the area of Healthcare Law.  According to the editor in chief, Arizona Business Magazine made its final selections from a pool of over 5,000 of “the best and brightest Arizona business leaders in healthcare, real estate, construction, education, banking, financial services and law.  Over the course of more than two dozen meetings, that list of 5,000 leaders under consideration was pared down to about 500 names, which the selection panel considered to be the most influential leaders in their industries, broken down into categories.”

Other Arizona leaders named in 2015 include U.S. Senator John McCain, Phoenix Mayor Greg Stanton, and sports executive and former owner of the Phoenix Suns, Jerry Colangelo.

What to Do When Your
Disability Insurance Claim Is Denied

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claim denied man - black and white

A large part of our practice consists of helping physicians and dentists whose disability insurance claims have been denied or terminated.  When our clients come to us, we carefully analyze their medical records, the claim file, and the law to craft a specific strategy for getting the insurer to reverse its adverse determination.  Unfortunately, we sometimes find that in between receiving notice that their claim has been denied or terminated and getting in touch with our firm, doctors will inadvertently take actions that prejudice their claims.  With that in mind, it’s important to review what to do and what not to do in the first few days after your claim is denied or terminated.

  1. In all likelihood, you will first find out that your insurer is denying or ending your disability benefits via a telephone call from the claims consultant who analyzed your claim.  As we’ve explained before, the consultant will be taking detailed notes about anything you say during that call.  Therefore, even if you are justifiably upset or angry, be very mindful of what you say.  Anything you tell the consultant will certainly be written down and saved in your file.
  2. During the call with your consultant, make your own notes.  You don’t have to ask a lot of questions at this stage, but you do want to make sure to record whatever information the consultant gives you.
  3. Following the phone call, you should receive a letter from the insurance company stating that it has denied your claim or discontinued your benefit payments.  According to most state and federal law, the letter should have a detailed explanation of the evidence the company reviewed and why the insurer thinks that evidence shows you aren’t entitled to benefits.  When you receive the letter, read through it carefully.  Make notes on a separate document about any inaccuracies you identify.
  4. Make sure you keep a copy of the denial or termination letter as well as the envelope it came in.  You should also make a note of the date on which you received the letter.  The date the letter was actually mailed and received could be important to your legal rights in the future.  Then, the best thing to do is to scan the documents electronically or make a photocopy for your file, just in case the original denial letter gets lost or damaged.
  5. Once you find out that your claim has been denied or terminated, you should contact a disability insurance attorney.  Some doctors and dentists attempt to handle an appeal of their claim on their own, but we strongly suggest at least consulting with a law firm.  Every insurance  company has its own team of highly-trained claims analysts, in-house doctors, and specialized insurance lawyers to help it support the denial of your claim.  Having your own counsel can level the playing field by making sure you know your rights under your policy and what leverage the applicable law provides you, and help you avoid the common traps that insurance companies lay for claimants on appeal.
  6. The lawyer you consult can be in your area, or it can be a firm with a national practice that’s physically located in another state.  You may want to review these questions to ask potential attorneys before you decide who you would like to represent you.
  7. Whatever attorney you choose to contact, make sure you do so as soon as possible.  In many circumstances, you will only have a limited amount of time to appeal the insurance company’s decision.  Particularly in claims governed by the federal law ERISA, the clock starts ticking as soon as you find out your claim has been denied or terminated.
  8. It’s usually best to contact an attorney before you respond to the denial letter, to avoid saying anything that could prejudice your appeal.  For instance, if you have a policy that is governed by ERISA, and you submit some additional information, the insurance company may not allow you to submit any additional information after your initial response.
  9. Before you meet with potential disability insurance lawyers, gather whatever documents you can to help them evaluate what’s going on with your claim.  Our firm will always want to review the insurance policy or policies.  (Here’s information on how to get a copy of your policy). We typically also like to see your relevant medical records and any correspondence between you and your insurance company.  If you aren’t able to locate this information, it could cause delays in starting the appeal process.
  10. If you are a physician or dentist that is totally disabled, you should not try to go back to work just because your insurance company thinks you don’t qualify for benefits.  Trying to practice when you aren’t in a physical or mental condition to do so could cause you to re-injure yourself or accidentally harm your patients.  Of course, trying to work on patients after you’ve claimed that you are totally disabled can expose you to professional liability as well.  Further, trying to return to work could impair your ability to collect your benefits upon appeal.

Field Interviews: What to Expect After the Interview Ends

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We’ve discussed why an insurer might want to schedule a field interview and what to expect before and during the interview itself.  Now we review what claimants can expect can expect after the interview ends.  Again, the process is usually different depending on whether not a disability insurance attorney is involved.

After the Field Interview

After your interview ends, the field representative will leave to do some additional reconnaissance.  Without telling you, the representative may drive to your office to talk to people on your staff.  He or she will see what the office looks like, if it’s busy, and whether your name is still listed on the door.  If you have an attorney, the attorney will have discussed this with you ahead of time, and together you will have taken steps to make sure the representative doesn’t bother your staff or catch them off guard.

Some days after the field interview, the representative will send you a copy of his or her report, which purports to summarize your conversation.  The report will ordinarily be 8 to 10 pages or more.  He or she will ask you to review the report, make any changes you see fit, and return it.  The representative will advise that if you don’t make any changes by a certain date, he or she will assume that everything in the report is accurate.

For claimants with legal representation, the report will be sent to your attorney’s office. Your attorney will review the report to make sure that it accurately reflects the facts of your claim.  He or she should be able to correct any seemingly harmless statements that a claims adjuster may take out of context to support denying or terminating your claim.  If any important information is missing, your attorney will make sure to include it along with the report.

Meanwhile, the field representative will usually send a separate report to the insurance company.  This second report will have the representative’s personal observations about you, their conversations with your staff, and any other information he or she was able to gather about your outside of the interview.  You will not be provided with a copy of this report unless you’re able to obtain the claim file after your claim has been terminated or denied.  If you have an attorney, this second report will be much more limited, as the representative will not have had the opportunity to visit your home or to pry into irrelevant or confidential information.  If your claim is denied or terminated, your attorney will obtain and review this report for any inaccuracies or misstatements.

A field interview can be intimidating, but knowing why the interview is being conducted and what to expect during the process can make you better prepared to handle it in a way that doesn’t prejudice your claim.  If you have questions or concerns about a field visit, contact a disability insurance lawyer right away.

Field Interviews: What to Expect Before and During the Interview

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Our last post discussed why an insurance company might want to conduct a field visit or field interview.  Now that you know what the insurer is trying to accomplish, we’ll discuss what exactly to expect before the interview, during the interview, and afterwards.  As with many aspects of the claims process, the field interview will be different depending on whether or not you have a disability insurance attorney involved.  First, what to expect before and during the interview:

Setting Up the Field Interview

Initially, the field representative will call or e-mail you personally to set up a time to meet.  He or she will ask to come to your home, or sometimes your office (particularly if you have been practicing as a dentist or physician), and talk one-on-one. If you’re being represented by a disability insurance lawyer, the field representative will call or write a letter to the lawyer’s office to request a field interview.  Your attorney will evaluate whether the in-person interview is necessary and appropriate under the terms of your policy and your particular claim situation.  If so, your attorney will likely ask the field interviewer to meet at the attorney’s office, rather than in your home or office.  Your attorney, and sometimes an assistant as well, will attend the interview.  The attorney and/or his or her assistant will take careful notes of the entire conversation.

During the Field Interview

When the representative arrives, he or she may ask to take your photograph.  The representative may also ask to audio-record your conversation.  If an attorney is present, the representative will usually refrain from asking to take a photograph or audio-record the conversation, knowing that your legal counsel will likely determine it unnecessary and/or inappropriate.

The field representative will sit down and talk with you for an hour or more.  He or she will have an extensive list of questions to ask you, most of which your claims analyst will have specifically requested the representative address. For those with legal representation, your attorney will have prepared you for each of the questions the representative will ask, so you’ll be ready to give accurate and well-considered answers.

During your conversation, the representative will be very warm and friendly.  The representative will normally try to establish a rapport so that you’ll relax and talk openly.  He or she will try to get you to talk without thinking, encourage you to go into unnecessary detail, and may ask personal questions that a claims adjuster would normally avoid.

The representative often acts somewhat more reserved when an attorney is present.  Field representatives know that if they ask any questions that are irrelevant, seek confidential information, or are otherwise inappropriate, your attorney will intervene and let you and the representative know that you don’t need to answer the question.

While you’re talking, the field interviewer will take copious notes.  These notes will include the interviewer’s own observations about your appearance, how well you move, how long you were able to sit or stand, what your house looks like (if in your home), and whether you seem nervous or not.  If your attorney attends, the representative will know that his or her notes will be compared against the attorney’s, so he or she will be especially careful to document the circumstances accurately.

In our next post, we’ll talk about what happens after the field interview ends.

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