Reader Poll:
Which disability insurance company has the worst reputation?

After helping physicians and dentists on claims with every major private disability insurance carrier, we have our own opinions on which companies are the most notorious for targeting and denying claims.

We’re curious what our readers think.  Which of these leading individual disability insurance companies do you feel has the worst reputation?  Take our anonymous poll and see what others say, too.


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Will Physical Therapy Help Your Back Pain?

In previous posts, we have discussed some of the methods used to treat back pain. One common method of treatment is physical therapy. However, according to a recent study published in JAMA, physical therapy may not provide significant benefits for patients suffering from lower back pain.

The JAMA study divided patients with back pain into two groups. The first group participated in sessions with a physical therapist. The second group was simply told that the pain would get better if they maintained an active lifestyle.

Although the physical therapy group demonstrated more improvement over the first 3 months (based on a scale that measures disability from lower back pain), after 1 year both groups’ results were substantially the same.

Additionally, the study did not find any meaningful differences in the groups’ pain intensity, quality of life, or number of visits to health care providers.

Thus, the study would seem to suggest that while physical therapy may help for a limited amount of time, in the long run it may not necessarily be an effective treatment method for back pain.

Notably, the sample size for the study was small (207 people), so further research may be necessary to more precisely determine the extent of the benefits provided by physical therapy.

See also http://well.blogs.nytimes.com/2015/10/14/physical-therapy-may-not-benefit-back-pain/?smid=tw-nytimeswell&smtyp=cur&_r=0.


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Case Study: Can You Sue Your Insurer For Emotional Distress?

At least one court thinks so. In Daie v. The Reed Grp., Ltd.[1], the claimant was denied long term disability benefits under an ERISA plan. Instead of merely asking the court to reverse the denial of benefits (a result that can be difficult to achieve under ERISA), claimant filed a complaint in state court alleging intentional infliction of emotional distress.

The claimant asserted that the insurer “repeatedly engaged in extreme and outrageous conduct with the aim of forcing plaintiff to drop his claim and return to work.”  Id. More specifically, the claimant alleged that the insurer had falsely claimed the claimant was “lying” about his disability and “exaggerating” his symptoms. Id. According to the claimant, the insurer had also urged claimant to take “experimental medications,” induced claimant to “increase his medications,” forced claimant “to undergo a litany of rigorous medical examinations without considering their results,” and pressured claimant “to engage in further medical testing that it knew would cause . . . pain, emotional distress and anxiety.” Id.

The insurer filed a motion to dismiss, arguing that ERISA preempted claimant from bringing the state law claim. The court denied the motion to dismiss for two reasons. First, the court determined that the claim was based on “harassing and oppressive conduct independent of the duties of administering an ERISA plan.” Id. Second, the court determined the insurer had a “duty not to engage in the alleged tortious conduct” that existed “independent of defendants’ duties under the ERISA plan.”  Id.

The federal court then sent the case back to state court, where, as of the date of this post, the state court has not yet determined whether claimant should be awarded damages for emotional distress.

At this point, this ruling has only been adopted by the District Court, and not the Court of Appeals, so it is not binding upon other courts. However, it could potentially persuade other courts to recognize similar claims. It will be interesting to see how many other courts follow suit, and whether this ruling will ultimately be adopted by courts at the appellate level.

[1] No. C 15-03813 WHA, 2015 WL 6954915, at *1 (N.D. Cal. Nov. 10, 2015).


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The Reality of Addiction: Physicians Are Susceptible Too

We’ve discussed the prevalence of depression and stress in physicians, but what about addiction?  While physicians are just as likely as the general public to become dependent upon alcohol and illegal drugs, they are more likely to abuse prescription drugs.  A survey of 55 physicians that were being monitored by their state physician health programs for problems relating to drug and alcohol abuse showed that 38 (69%) abused prescription drugs.  While certainly concerning, this is not necessarily surprising, as physicians have far greater access to prescription drugs than the average person.

Compounding this issue is the stigma associated with substance abuse.  Oftentimes, those who do not suffer from substance addiction believe that drugs and alcohol are something that people can quit easily, and that substance abuse can be solved by a quick trip to a rehab facility.  But in many cases, substance abuse is more than mere recreational use of medications.  In some cases, those who abuse prescription drugs may be trying to relieve stress or self-medicate chronic physical and/or emotional pain.  In other cases, substance abuse may be a result of the phenomenon called “presenteeism”—doctors may be taking the medication simply because they believe it is the only way to continue working in spite of an illness, impairment, or disability.

How can medical professionals with substance addiction get help? One way is to seek confidential treatment to avoid the scrutiny of a medical board or coworkers.  Confidential programs can be both outpatient and inpatient, with inpatient programs usually lasting around one to three months.  After treatment, patients are able to continue recovering by completing 12–step programs, like Alcoholics Anonymous.  However, this treatment option has similar relapse rates to the general public: nearly half of patients relapse in the first year.

A second road to recovery is physician health programs.  These programs actively monitor patients after treatment for a period of five years by conducting drug testing, surveillance and behavioral assessments.  This path may be difficult for physicians to come to term with after keeping their addiction hidden.  However, going through the physician health programs boasts a much higher success rate of 78% (only 22% tested positive during the 5-year monitoring period), and roughly 70% of medical professionals who pursue this method of treatment are still working and retain their licenses.

If you, or a physician you know, struggles with substance dependency, we encourage you to seek out appropriate help.  If you are a physician with a painful disability, you should not put your patients at risk by attempting to work through the pain or by seeking to dull the pain with self-medication.  If you have disability insurance, you should contact an experienced disability insurance attorney.  He or she will be able to guide you through the claims process and help you secure the benefits that you need without putting yourself or your patients at risk.

REFERENCES:

http://www.medscape.com/viewarticle/819223_3.


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DOL Proposes Changes to ERISA

In prior posts, we have noted that employer-sponsored disability plans are generally governed by ERISA. We have also discussed some of the challenges claimants may face when filing a claim under ERISA.

Recently, the Department of Labor (DOL) proposed some new regulations that could make filing a claim under ERISA more claimant-friendly. If finalized, the regulations will change several aspects of the claims process under ERISA. Some of the most notable changes are as follows:

  • At both the initial claim stage and the appeal stage, insurers will have to provide a detailed explanation for their denial, including their bases for disagreeing with the claimant’s treating physician, the Social Security Administration, and/or other insurers who are paying benefits under other policies the claimant may have.
  • Insurers will have to notify claimants at the initial claim phase that the claimant is entitled to receive and review a copy of their claim file (right now, insurers only have to do this at the appeal stage).
  • During the appeal stage, insurers must automatically provide claimants with any new information that was not considered at the initial claim stage so that the claimants can review and respond to the new information.
  • If an insurer violates the new rules (and it is not a minor violation) claimants can file suit immediately and the court must review the dispute de novo (i.e. without giving special deference to the insurer’s claim decision).

Some of these rules have already been established by case law, but as of right now, they are not uniformly applied across the country. If the DOL moves forward and finalizes the regulations, insurers and plan administrators will have to uniformly comply with these new rules when administrating ERISA claims.


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Unique Conditions

In past posts, we have looked at some conditions that are common in doctors and dentists—such as carpal tunnel syndrome and essential tremors—and discussed ways that these conditions can affect both your practice and your disability insurance claim.   In this post, we will be discussing a few unique conditions that—while they may not be severe enough to cause you to file for disability benefits—can be particularly inconvenient for doctors and dentists.

Left–Right Confusion

Roughly 15% of people suffer from a condition that makes it difficult for them to differentiate between their left and their right.  While this may be a mere annoyance for most people, it can be a significant problem for a doctor or a dentist.

One doctor tells the story of how he mistakenly ordered an x-ray for the wrong foot of a patient, and the radiologist insisted on performing the x-ray on the foot that the doctor had indicated even though it was very obvious which foot was injured.[1]  Due to the confusion, the patient ended up leaving the doctor’s care.  In other, more extreme cases, “wrong-side surgery” has occurred due to left-right confusion.

Face–Blindness

Face-blindness, or prosopagnosia, is a cognitive disorder that affects people’s ability to identify faces and places.  It is much less common than right-left confusion, occurring in only about 2.5% of people.  Face-blindness also exists on a spectrum, with some people having mild prosopagnosia, while others are unable to pick out the faces of their spouses or children in a crowd.

While face-blindness doesn’t necessarily have a large effect on operations, it can negatively impact your relationships with patients.  For instance, if patients are unaware that you suffer from face-blindness, they may be offended if you fail to recognize them outside the office setting.  Fortunately, in most instances, prosopagnosics can use other characteristics, such as posture or voice, and contextual clues, such as location, to identify an unfamiliar face.[2]

Dyslexia

Like left-right confusion, dyslexia also affects approximately 15% of Americans.  This condition affects the way that the brain processes language, both written and spoken.  It is often referred to as a “reading disability,” but it can also affect writing, spelling, and speaking.  Although there are various therapies designed to minimize the effects of dyslexia, in most cases dyslexia is a lifelong condition.

Many doctors with dyslexia do not reveal their condition for fear of stunting their professional growth or causing patients to lose trust.  However, as one dyslexic doctor has observed, first-hand awareness of personal deficiencies can actually enhance patient trust, because it can make a physician more compassionate and understanding.[3]  Another dyslexic doctor considers her dyslexia to be a gift because it has made her a more creative problem solver and enhanced her ability to recognize patterns, which has proved very useful in her chosen field of radiology.[4]

Conclusion

While these conditions may not be severe enough to support a disability insurance claim, they can change the way that you approach your practice and patients.  It’s important to be aware of these conditions because even if you don’t have any of these conditions, a colleague or patient might.  We encourage you to be cognizant and understanding of others’ disabilities, and to foster a culture of acceptance and accommodation in the medical field.

[1] See http://well.blogs.nytimes.com/2015/08/10/you-will-see-the-doctors-fallibility-now/?smid=tw-nytimeswell&seid=auto.

[2] For more info on face-blindness, see http://www.newyorker.com/magazine/2010/08/30/face-blind.

[3] See http://www.reuters.com/article/2015/02/26/us-dyslexic-physicians-idUSKBN0LU2E520150226.

[4] Id.


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Are Insurance Companies Discriminating Against Mental Health Claims?

In previous posts, we have noted that disability policies often limit the disability benefits available for claimants who suffer from mental health disorders. For example, many policies limit recovery under a mental health disability claim to a 2 or 3 year period. In contrast, most policies provide benefits for physical disability claims to age 65, and some policies even provide lifetime benefits for physical disability claims.

Recently, Representative Ruth Balser has introduced a bill in the Massachusetts state house that would prohibit insurance companies from treating behavioral health claims differently from physical impairment claims. According to Representative Balser, offering shorter benefit periods to claimants with mental health disorders is discrimination.

Supporters of the bill contend that the way that disability insurers currently handle mental health is based on stigmas and ignores available treatments options.  Supporters of the bill also argue that the bill will reduce government costs because individuals with mental health issues will no longer need to rely on Social Security or government welfare programs.

The insurance industry’s response is that requiring insurance companies to provide more coverage will cost businesses money because it will limit available options when buying insurance and force them to buy coverage that they do not want. The insurance companies also argue that the bill will actually result more people relying on government programs because they will not be able to afford the increased levels of coverage.

At the moment, the bill is still being considered in committee, so it has not yet become law. However, if the bill is ultimately passed, it could significantly alter the way insurance companies treat mental health disability claims, particularly if other states pass similar laws.

For more information, see http://www.milforddailynews.com/article/20151016/NEWS/151017038.


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Fibromyalgia: Part 2

In Part 1 of this post, we listed some of the symptoms and potential causes of fibromyalgia.  In Part 2, we will discuss some proposed treatments for fibromyalgia.

Treatment

Unfortunately, while there are a variety of ways to treat fibromyalgia, there is currently no cure for fibromyalgia.  Some of the most prominent courses of treatment include:

  • Exercise: Many fibromyalgia patients may be afraid to exercise because they think it will increase their pain.  However, being active may help to alleviate pain because physical activity can increase endorphin levels that patients may be lacking.  Exercise can also alleviate stress, anxiety and depression—common symptoms of fibromyalgia.
  • Physical Therapy: Some physical therapists utilize exercises that help fibromyalgia patients relax tense muscles and move in ways that will not exacerbate pain levels. Physical therapy is often used as a precursor to exercise.
  • Medication: Antidepressants are often prescribed to help with the depression, fatigue, and sleep issues associated with fibromyalgia. Medications that facilitate restful sleep may also help with the pain, by allowing patients the rest needed to recover.  Other drugs, such as Lyrica, have been approved by the FDA to directly treat fibromyalgia pain.  Remember, you should always consult with your doctor before taking any medication.

Conclusion

Fibromyalgia is a condition that varies from person to person, with people having both good and bad days.  If you suffer from fibromyalgia, note what makes your pain worse or better, and try to avoid or continue those practices.  As always, it is important to consult with your doctor to ensure that you are receiving appropriate treatment for the chronic pain caused by fibromyalgia.

If your fibromyalgia has progressed to the point where you can no longer practice, we encourage you to contact an experienced disability attorney before filing a disability claim.  Disability claims involving fibromyalgia can be particularly difficult, due to the subjective nature of the condition, so it is important to have an experienced advocate at your side to help you navigate the claims process.


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Fibromyalgia: Part 1

In this post, we are going to take a look at some of the symptoms and causes of a debilitating condition known as fibromyalgia.

Symptoms

Fibromyalgia is a syndrome that is characterized by chronic, widespread muscle pain. Other symptoms include:

  • Fatigue;
  • Trouble sleeping;
  • Morning stiffness;
  • Muscle knots, cramping, or weakness;
  • Painful trigger points;
  • Dry eyes;
  • Concentration and memory problems, called “fibro fog”;
  • Irritable bowel syndrome;
  • Anxiety or depression; and
  • Headaches.

Fibromyalgia is difficult to diagnose, because most of the symptoms are relative or subjective.  Notably, certain forms of arthritis may cause similar symptoms.  However, persons with arthritis suffer from pain that is localized in joints.  In contrast, persons with fibromyalgia suffer pain that is primarily felt in muscles, tendons, and ligaments.

Potential Causes

Because fibromyalgia is difficult to diagnose (due to the subjective nature of its symptoms), there is no clear consensus as to the causes of fibromyalgia.  Here are some of the theories that researchers have suggested:

Lower Levels of Serotonin and Endorphins

Serotonin is a neurotransmitter that is associated with calming and feelings of well-being and happiness.  Endorphins are also associated with happiness and serve as painkillers.  If someone has lower levels of serotonin and endorphins, they may be more susceptible to feeling pain, or may feel pain more intensely than someone with normal serotonin and endorphin levels.

Stress

Some researchers theorize that stress causes muscle “microtraumas,” which in turn leads to a cycle of pain and fatigue caused by an inability to rest due to the pain.

Gender and Biological Changes

Statistically speaking, women seem to be at greater risk for fibromyalgia.   For this reason, some scientists have proposed that fibromyalgia pain may be connected to hormonal changes such as menopause.

Heredity/Genes

Fibromyalgia could be due to a genetic tendency that is passed down and regulates the way one’s body processes pain.  Although, as of yet, no particular “fibromyalgia gene” has been identified, several genes have been found to occur more often in people with fibromyalgia.

Trauma

Accidents, injury, and illness involving the brain or spinal cord may contribute to fibromyalgia pain.  Such trauma may alter the way neurotransmitters, such as serotonin, are produced, or it may lower an individual’s emotional threshold for pain.


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Karla Thompson Discusses Common Claim Mistakes
in U.S. News & World Report

Comitz | Beethe Associate Karla Thompson recently spoke with Geoff Williams, a journalist for U.S. News & World Report Money, about common mistakes consumers make when they file insurance claims.

In the article, Ms. Thompson discusses one of the chief errors that can lead to a claim being denied: talking to claims analysts on the phone.  Mr. Williams writes:

If you’re a conversationalist and enjoy talking, be careful. Karla Baker Thompson is a Scottsdale, Arizona-based insurance attorney who specializes in representing professionals with disability insurance claims.

“Most people don’t realize how claims handlers are trained to ask loaded questions whenever they talk to policyholders, and to memorialize everything the claimant says in a written memo after the call,” Thompson says. “The questions might seem routine or mundane to the policyholder, but the answers they elicit can have serious consequences, including denial of the claim.”

Thompson offers the example of a claims handler asking what you’ve been doing that day.

“If you say you went out to pick up a prescription, you’re not just making small talk. You’ve just led that claims adjuster to believe – whether accurately or not – that you’re capable of leaving the house, getting in your car, driving, filling out paperwork, and possibly lifting and carrying bags,” Thompson says.

Maybe, Thompson adds, someone drove you to get that prescription, or maybe you did go out yourself but you came back and felt miserable afterward.

“If you’re just speaking off the cuff, you may not be giving the proper context to your answers,” she says. “Worse, you could say something inaccurate by mistake.”

Other examples in the article include assuming your insurance company is right and not getting the proper documentation to support your claim.

Check out the article in its entirety to learn more: Don’t Make These Mistakes When Filing an Insurance Claim.


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