Carpal Tunnel Syndrome and You: The Issue, and 10 Things You Can Do to Prevent It

Carpal Tunnel Syndrome consists of pain, weakness, numbness, or tingling in the fingers or hand caused by pressure on the median nerve in your wrist. The median nerve controls the feeling and movement in the thumb and all of the fingers except the pinky. For a dentist, this syndrome can be quite debilitating, as this profession requires the full use of both hands in order to examine and perform surgery on patients. Today, we’re going to take a closer look at the symptoms and causes of Carpal Tunnel Syndrome, as well as 10 steps you can take to prevent it from happening.

Symptoms and Causes

While there are multiple symptoms of Carpal Tunnel Syndrome, there are a few that are rather noteworthy:

• Sleep interruption from numb hands and tingling fingers: you may think that the numbness and tingling is simply due to sleeping on your hand in an awkward position, but there may be more to it than that.
• Loss of fine motor skills/weakness in hands.
• Pain radiating up the arm: it may just radiate up the forearm, or it could potentially also make your shoulder and neck ache.
• Hand pain or wrist pain: this is perhaps the most straightforward symptom of the syndrome.
There seems to be no one cause of Carpal Tunnel Syndrome, but there are several risk factors, including:
• Anatomic factors: wrist fractures or dislocations can lead to extra pressure on the median nerve.
• Sex: the syndrome is more common in women.
• Inflammatory conditions: illnesses such as rheumatoid arthritis.
• Workplace: working with vibrating tools, holding static positions for a long time, repetitive motions with the wrist. These workplace factors put dentists at a higher risk for contracting Carpal Tunnel Syndrome than the general population.

Continue reading Carpal Tunnel Syndrome and You: The Issue, and 10 Things You Can Do to Prevent It


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Do You Need Disability Insurance for More than Just Yourself?

We spend a lot of time talking about disability insurance claims and mostly focus on the big one: personal disability insurance. However, there are three other types of insurance that you may not have been aware of, and could be potentially helpful to you and your practice. Today, we’ll be taking a look at key-person disability insurance, buyout disability insurance, disability insurance for overhead, and, of course, personal disability insurance. We will also discuss whether or not you potentially would need any of these forms of insurance.

Personal Disability Insurance

Essentially, disability insurance is insurance that you buy for yourself in the event that you become disabled while working. If you work in a profession where disability is a possibility, it is important to have personal disability insurance for the sake of your future. For instance, dentists are at higher risk for disability due to repetitive movements and static positions, so it is crucial for them to have a disability policy.

Further, we recommend that you purchase an individual disability insurance policy for yourself, and not through an employer-sponsored program. This makes sure that the policy is not covered by ERISA in the event that you do have to file a claim.

Key-Person Disability Insurance

Key-person disability insurance is a type of coverage for those that own their own business or practice. This form of insurance covers an employee that is “key” to your business: someone who would be impossible to replace due to their skill, customer base, knowledge or burden of responsibility. If this person was to become disabled, and you had key-person disability insurance, the business would receive disability income checks. These checks could be used to cover the financial loss of the missing employee, or it could pay for a temporary worker while the insured person recovers from the disability.

There are several things to consider when determining if you should buy key-person disability insurance. These include the contingencies for the company if a key employee is disabled, the time to find and train a suitable replacement, the amount of revenue directly attributable to the key person, whether or not the key person’s disability will result in the loss of clients, and whether your company is willing to self-insure.

Unlike personal disability insurance policies, key-person policies are limited in their features and options. Often, they are custom designed for the company so that they meet specific needs, and are also often very short term, lasting between 12–24 months. This is because it is usually assumed that you could find and train a replacement in that time span.

Continue reading Do You Need Disability Insurance for More than Just Yourself?


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Presenteeism & Sick Doctors: Does This Lead to More Sick People?

We’ve discussed the issues involved with “presenteeism” and how it can affect disability insurance claims, but it’s making waves in other news regarding healthcare workers and their patients. Healthcare workers are going to work sick, and while it is admirable to be dedicated to your job, it creates a huge risk to those with already compromised immune systems. Since healthcare workers are entrusted with the duty of caring for high risk patients, it’s important that we take care of our healthcare workers as well. However, that seems to not be the case, as in the medical field it is seen as weak to take days off, and sometimes taking more than two sick days is rewarded with an extra week of work for residents.

Here are some statistics that highlight this phenomenon:

95.3% of 504 physicians believed that working while sick put patients at risk. 1)http://archpedi.jamanetwork.com/article.aspx?articleid=2344551

83.1% of the 504, however, worked sick at least 1 time in the past year.

98.7% didn’t want to let colleagues down, and 64% feared being shunned by colleagues.

80% of a random sampling of 1,033 Norwegian physicians reported working even though they had symptoms that in a patient would be considered “sickness”. 2)http://www.ncbi.nlm.nih.gov/pubmed/11355720/

However, it’s imperative that we don’t blame healthcare workers, but instead society and its approach to doctors’ and dentists’ sickness as a whole. It doesn’t seem to make sense that we place such a heavy emphasis on coming to work no matter what when lives are at stake. While it would seem to be common knowledge that placing an already compromised immune system in jeopardy would be a bad idea, the medical community’s desire to work through diseases is contradictory to this, and perhaps it’s time to change the culture.

Physicians, what do you think about “presenteeism”, and how do you think we can change the culture surrounding it? Tell us in the comments.


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References   [ + ]

1. http://archpedi.jamanetwork.com/article.aspx?articleid=2344551
2. http://www.ncbi.nlm.nih.gov/pubmed/11355720/

Protecting the Protectors: Depression, Medical Professionals, and the Conflicts Involved with Under-reporting

Depressed-Doctor

Today we’re taking a closer look at how depression can affect doctors and dentists, their practices, and the way they file for disability insurance. We examine how the medical community’s approach toward mental health is perhaps preventing some doctors from reporting illness, and how this changes a doctor’s ability to obtain adequate treatment and secure disability insurance benefits.

Depression and anxiety are undeniably prevalent among physicians and dentists.  For instance, a study in Australia showed that the rates of depression in doctors is four times higher than the general population and in a British study, 60% of dentists surveyed reported being anxious, tense, or depressed.

Simply looking at the daily life of doctors, and comparing that to the risk factors for depression shows some striking connections between the two. Some of the risk factors associated with depression (as outlined by the Mayo Clinic) include being overly self-critical, having serious or chronic illness and dealing with traumatic or stressful events. Interestingly, these are many things that doctors and dentists struggle with; indeed, probably more often than the average person. Doctors and dentists have to be self-critical because if they aren’t, lives could be at stake. In addition, doctors and dentists often suffer from chronic illness and pain due to the physically and emotionally taxing nature of their work. Worrying about patients, running a practice, and working long hours are all part of the job description for the average doctor.

While physicians and dentists commonly have symptoms of depression, they often don’t report their issues due to the stigma of mental health issues within the medical community. Lay people look to doctors and dentists as the paragon of health, and physicians take the same approach: while their patients are characterized by their illness, physicians are supposed to be the ones who cure them. While the general populace’s approach to mental illness has improved greatly over time (we no longer lock people in tiny jail cells simply because they are mentally ill), the negative stigma attached to depression and anxiety in the medical and dental community is still present. In the Australian study noted above, half of the respondents reported thinking that they were less likely to be appointed to a new position if they had a history of mental illness, and 40% admitted thinking less of doctors that have a history of depression or anxiety.

Nevertheless, it is important for doctors to recognize whether they exhibit signs of mental illness. Aside from needing to be mindful of their own health and well-being, doctors are responsible for the health and well-being of their patients, too.  Physicians and dentists both are in the unique position that a mistake that they make at work could endanger a life. Attempting to work through depression and anxiety symptoms that impair the doctor’s ability to provide responsible patient care could lead to a malpractice suit. Perhaps the solution to this issue is a re-evaluation of the medical community’s approach to mental illness. While that seems like a large task to take on, it starts with each individual doctor either seeking treatment for mental health, or supporting those that do.

For physicians, states have programs in place called Physician Health Programs (PHPs) that are supposed to support the health, including mental health, of medical licensees. A PHP is advertised as a way to get the help one needs, while avoiding disciplinary action such as a loss of license. Physicians should be aware, however, that PHPs are often connected to the licensing boards, and non-compliance with the PHP can lead to disciplinary action. For example, in Arizona, while the PHP is operated by an independent agency, it does have a formal contractual relationship with the state licensing board.

Continue reading Protecting the Protectors: Depression, Medical Professionals, and the Conflicts Involved with Under-reporting


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Arthritis and Its Many Forms: How It Affects Dental Professionals

The number one cause of disability in America is arthritis, which afflicts over 50 million people. With a U.S. population of 320 million this means that 1 person in every 6 has arthritis. These large numbers could be due to the fact that there are over 100 different types of arthritis ranging from lupus to gout. In this post, we will look to focus on the three most prevalent types of arthritis: osteoarthritis, rheumatoid arthritis and psoriatic arthritis. We will also discuss how they can affect your practice as a dentist, and how to approach a disability insurance claim for arthritis.

The Basics: Symptoms, Causes & Treatment

Osteoarthritis (OA) is the arthritis that arises simply from the overuse of joints, and for this reason it is known as “wear and tear” arthritis. Symptoms include pain, swelling and stiffness in the joints after either overuse or long periods of inactivity. It is most commonly developed as people naturally age and their bodies reflect that age, but can also be found in professions with repetitive movements, such as dentistry.

Since OA is due to aging or the effects of repetitive motion, OA is often progressive. It is the most common form of arthritis, and treatment can range from added exercise and weight loss (where the main cause of the OA is obesity), to taking various pain relievers, and even surgery.


1)See Osteoarthritis of the Hand in http://www.webmd.com/osteoarthritis/osteoarthritis-of-the-hand h9991469_001

Rheumatoid arthritis (RA), on the other hand, is an autoimmune disease, and is three times more common in women than it is in men. The body’s immune system mistakenly attacks joints, which leads to inflammation that causes further damage. While the symptoms are similar to OA in that there is joint pain and swelling, rheumatoid arthritis also can bring about fevers, fatigue, and weight loss. The joint pain you may be experiencing is often symmetrical, meaning both sides of the body are affected, in RA.

Unfortunately, the causes of RA aren’t fully understood. Symptoms can start and stop, occasionally going into remission, but RA is usually progressive. Risk factors for RA include family history of the disease, smoking, periodontal disease, and microbes in the bowels. There is no cure for RA, and it is treated somewhat similarly to OA in that pain medication, increased exercise, and surgery can be used to try to alleviate symptoms.

2)See Rheumatoid Arthritis in http://www.ezhealthmd.com/medical-conditions/rheumatoid-arthritis/rheumatoid-arthritis-hand Continue reading Arthritis and Its Many Forms: How It Affects Dental Professionals


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References   [ + ]

1. See Osteoarthritis of the Hand in http://www.webmd.com/osteoarthritis/osteoarthritis-of-the-hand
2. See Rheumatoid Arthritis in http://www.ezhealthmd.com/medical-conditions/rheumatoid-arthritis/

Patrick Stanley Selected as a Sustaining Member of Arizona’s Finest Lawyers

PatAFL

 

Firm member Patrick Stanley, whose practice areas include disability insurance and healthcare litigation, was selected as a Sustaining Member of Arizona’s Finest Lawyers. Nominations to Arizona’s Finest Lawyers are governed by strict ideologies and are made by Sustaining Members, selectees, and members of the Executive and Advisory Boards. The AFL seeks to build a diverse membership of individuals who, through noteworthy achievement, have reached positions of honor and trust. A Sustaining Member must be highly skilled, have a well-known reputation for honor and professional behavior, and be dedicated to AFL’s mission and goals.


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Wearable Fitness Trackers and Disability Insurance Litigation: How Your Fitbit Could Help or Hurt Your Claim

Recently, courts have been exploring the use of data from wearable fitness trackers in litigation.  Devices like the FitBit, Jawbone UP, and Nike Fuelband have the capability to track all kinds of fitness-related data, such as steps taken, heart rate, temperature, calories burned, and sleep patterns.  In cases where someone’s physical abilities are at issue, as is often the case with disability insurance claims, this data can be valuable.  But who is this data most valuable to–the claimant or the insurance company?  And is that value outweighed by a claimant’s right to privacy?  These are questions yet to be fully addressed.

Benefits and Drawbacks.  For claimants, data from a wearable fitness tracker could be a great way to show how a disability has caused a cessation or downward trend in activity. Providing the data to an insurance company may give a better picture, over a longer period of time, than any single doctor’s visit or Independent Medical Examination.

On the other hand, providing wearable fitness tracker data to an insurance company could hurt a claim in several ways.  First, if your disability isn’t the type that would prevent you from walking (such as a hand injury, vision problems, orthopedic injuries where movement is part of physical therapy, etc.), step counts could be irrelevant. Nevertheless, data showing a high step count can give an insurance claims adjuster or a jury the erroneous impression that you are very physically active and thus not “disabled.”

Second, for claimants that haven’t accurately described their limitations to the insurance company, the tracker’s data can be presented as objective evidence that the claimants weren’t telling the truth.  For instance, if a claimant wrote on a claim form that he “never” walks for more than 10 minutes at a time, then he has a very unusual day where he had to walk for 30 minutes, the insurance company could use the fitness tracker data to argue that the claimant is a liar.  (In such a scenario, the claimant should have told the insurer that he “rarely” walks more than 10 minutes, or that he tries to avoid doing so, as opposed to saying he “never” does).

Third, inaccurate data could lead the insurer to make inaccurate conclusions. Wearable fitness trackers aren’t perfect.  Step trackers tend to log movements other than walking as steps, such as when the wearer raises her arms up and down.  Heart rate monitors will track increases in heart rate that are the result of mental or emotional stress in the exact same way they track increases caused by physical exertion.  There is also the possibility of human error that affects the accuracy of the data.  For example, if you forget to turn your device into “sleep” mode, it can’t track how restless your sleep is.

When Data Can Be Required.  An insured may or may not want to provide fitness tracking data to an insurance company voluntarily, but if the insurance company requests it, does the claimant have to comply?  The answer is less than clear.

In the claim context (when no litigation has ensued), the insurance company can only impose requirements covered in the policy.  Of course, policies don’t explicitly state that a claimant has to provide fitness tracker data–at least not yet.  However, an insurance company could argue that policy clauses requiring you to “cooperate” with the claims investigation or provide “proof of loss satisfactory to us” include a requirement to produce this type of data.  In those instances, it’s best to have an attorney evaluate the request to see if it is, in fact, required under the policy.

If a lawsuit has been filed, the insurance company may have more leeway when it comes to requesting wearable fitness tracker data.  While it is doubtful that an insurer could force a claimant to wear a tracker if he or she isn’t already, it’s easy to imagine a case where an insurer requests existing data from a device that a claimant already uses.

In federal courts, where most disability insurance cases are litigated, the insurance company can ask for any information that is relevant, or reasonably calculated to lead to the discovery of information that is relevant, to the claims or defenses in the case. The only exceptions are for things like privileged information (such as communications with your attorney) or requests that cause undue annoyance, embarrassment, oppression, or burden.

For data stored online, insurers could subpoena the data directly from the device manufacturer.  Fortunately, some fitness tracker manufacturers have already publicly stated that they will resist such subpoenas to the extent possible.  Insurance company lawyers are more likely to request that data from the claimant directly, in which case it becomes very important for the claimant’s attorney to evaluate whether that request is allowed under court rules.


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What Is A Discretionary Clause?

Discretionary clauses grant your insurance company substantial discretionary authority to interpret your policy and determine your eligibility for disability benefits.  If your disability policy contains a discretionary clause and your insurance company denies your claim, courts will generally be reluctant to overturn the denial.

Here is an example of a discretionary clause taken from a Unum policy:

DISCRETIONARY ACTS

The Plan, acting through the Plan Administrator, delegates to Unum and its affiliate Unum Group discretionary authority to make benefit determinations under the Plan. Unum and Unum Group may act directly or through their employees and agents or further delegate their authority through contracts, letters or other documentation or procedures to other affiliates, persons or entities.  Benefit determinations include determining eligibility for benefits and the amount of any benefits, resolving factual disputes, and interpreting and enforcing the provisions of the Plan.  All benefit determinations must be reasonable and based on the terms of the Plan and the facts and circumstances of each claim.

It is easy to see why discretionary clauses are “highly prized” by disability insurance companies.[1]  Such clauses not only grant your insurance company the authority to interpret the provisions of your policy, but also the authority to resolve factual disputes. The practical consequences of this are obvious:  any close calls regarding ambiguous policy language or the seriousness of your disability will be resolved in the insurance company’s favor.

Discretionary clauses also make overturning a denial of benefits much more difficult.  If your policy has a discretionary clause, the court can generally only overturn your denial if you prove that the denial was an “abuse of discretion” because it was “illogical, implausible, or without support in . . . the record.”[2]  In contrast, if your policy does not contain a discretionary clause, the court generally conducts a “de novo,” or independent, review of your claim.[3]  In some cases involving discretionary clauses, courts that would normally be willing to overturn a denial under de novo review have been compelled to uphold the denial under the more exacting abuse of discretion standard.[4]

Not surprisingly, because the “abuse of discretion” is a high legal standard, the inclusion of discretionary clauses in disability policies dramatically reduces policyholders’ chances of successfully challenging a denial of benefits.  A 2004 study found that only 28% of lawsuits to overturn denials of benefits were successful if the policy included a discretionary clause.[5]  In contrast, policyholders won 68% of similar cases involving policies that did not have discretionary clauses.[6]

Insurance companies’ abuse of discretionary clauses has led several states to outlaw them.[7]  You should avoid policies which include discretionary clauses.  If you already have a policy which includes one, talk to your insurance agent about finding a new policy.



[1] See Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355, 384 (2002).

[2] Saloma v. Honda Long Term Disability Plan, 642 F.3d 666, 667 (9th Cir. 2011).

[3] Id. at 673.

[4] See, e.g., Curtis v. Kansas City Life Ins. Co., 2011 WL 901992 (W.D. Ky. 2011).

[5] Brent Brehm and Corinne Chandler, California’s Ban on Discretionary Clauses in Disability and Life Insurance Policies, Advocate: Journal of Consumer Attorneys Associations for Southern California, June 2013.

[6] Id.

[7] The states that have outlawed discretionary clauses are:  California, Colorado, Hawaii, Illinois, Indiana, Kentucky, Maryland, Maine, Michigan, Montana, New Hampshire, New Jersey, New York, Oregon, South Dakota, Texas, Utah, Vermont, and Wyoming.  See American Health Insurance Plan’s (AHIP) “Limitations on the Use of Discretionary Clauses:  Summary of State Laws,” available at www.ahip.org.


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Disability Insurer Profiles: Great-West

Great-West Life & Annuity Insurance Company (“Great-West”) is the final disability insurance provider we will look at in our series profiling insurance companies that specifically market to physicians and dentists.

See our profiles of MassMutualMetLifeNorthwestern MutualGuardian, Hartford, and Standard.

Great-West, which also goes by the registered mark of “Great-West Financial,” was incorporated in 1907, and traces its roots to a Canadian parent company that was incorporated in 1891.  Due to the nature of the economy and other factors, many insurance companies have suffered substantial losses in the past few years, and Great-West is no exception.  Great-West’s net income recently dropped from 238.1 million in 2012 to 128.7 million in 2013.  Consequently, Great-West may be looking to substantially increase its profits by, for example, denying high paying disability claims.

Company:  Great-West Life & Annuity Insurance Company.

Location:  Greenwood Village, Colorado.

Associated Entities:  Great-West Lifeco Inc.; Great-West Lifeco U.S. Inc.; Great-West Life Assurance Company; Great-West Life & Annuity Insurance Company of New York; Great-West Capital Management, LLC; Great-West Funds, Inc.; GWFS Equities, Inc.

Assets:  $55.3 billion in 2013.

Notable Policy Features:  Great-West is the insurance company that provides group disability insurance for the American Dental Association (ADA), so if you have a Great-West policy, your claim will probably be governed by the terms of the ADA’s group disability policy.

Great-West frequently sends out notices of updates and changes to the underlying contract between the ADA and Great-West, so there is a chance that you may end up with insurance coverage that you did not bargain for at the point of sale.  Oftentimes these notices are full of legalese and insurance jargon, and may be difficult to understand.  Nevertheless, it is important for you to promptly review any notices you receive, because they may impact your disability coverage in significant ways.  If you receive such a notice and are unsure about what it means, an experienced attorney can explain how the changes outlined in the notice will impact your policy.

Additionally, if you have a Great-West policy, you should be aware that your policy may contain a very strict provision requiring you to obtain proper medical care for your condition.  For this reason, if you are thinking about filing a disability claim with Great-West, you should make sure that your medical treatment is both well-documented and “appropriate” under the policy’s terms.

Claims Management Approach:  How Great-West administers your claim will depend on the terms of the policy at the time you file your claim.  Because the terms of the ADA’s group disability policy are renegotiated on a regular basis, the terms of your policy will likely change over time.  Since your initial copy of the policy may no longer be accurate by the time you file your disability claim with Great-West, be sure to ask for a copy of the current version of your policy so that you know your rights under your policy.

These profiles are based on our opinions and experience. Additional source(s): Great-West Financial’s 2013 Annual Report; www.greatwest.com.


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Disability Insurer Profiles: Standard

Standard is another disability insurer we will look at that specifically markets its policies to physicians and dentists.

See our profiles of MassMutual, MetLife, Northwestern Mutual, Guardian, and Hartford.

StanCorp Financial Group (“StanCorp”) was founded in 1906 and uses the marketing name “The Standard” to refer to its primary subsidiaries, which include the Standard Insurance Company and the Standard Life Insurance Company of New York.  In 2013, StanCorp received $351.7 million in pre-tax income, and $272.4 million (approximately 77%) of that income was attributable to profits from StanCorp’s insurance services.  StanCorp is particularly proud of its consistent long term growth and—given the fact that 77% of StanCorp’s profits come from its insurance services—StanCorp has an obvious incentive to deny high paying claims submitted by physicians and dentists.

Company: StanCorp Financial Group, Inc.

Location: Portland, Oregon.

Associated Entities: Standard Insurance Company; The Standard Life Insurance Company of New York; StanCorp Investment Advisers, Inc.; Standard Retirement Services, Inc.; StanCorp Mortgage Investors, LLC.

Assets: $22.73 billion in 2014.

Notable Policy Features:  If you are considering a Standard disability insurance policy, you should pay particular attention to whether the policy allows for total disability benefits if you are working in another occupation.  Oftentimes, Standard policies will pay nothing more than residual disability benefits if you are able to secure other part-time employment.  For example, if you can no longer practice dentistry, but you are able to teach classes at a dental college, Standard may refuse to pay you total disability benefits.  If you are eligible for residual benefits, Standard will require you to submit proof of your income every single month.

Read more about the difference between total disability benefits and residual disability benefits.

Claims Management Approach:  Standard tends to demand strict compliance with its claims procedures, and Standard will generally not be very accommodating if you make a mistake.  This can be problematic, because, for many policyholders, the claims process is unfamiliar and daunting.  If you are dealing with Standard, be sure to ask for a detailed explanation of what is required of you.  You should pay close attention to deadlines, as they will likely not be flexible.  You should also make sure that you use Standard’s forms when providing attending physician statements or other documentation of your disability, because Standard will not accept other insurers’ forms.

These profiles are based on our opinions and experience. Additional source(s): “Quick Facts About the Standard” and “About the Standard,” available at www.standard.com; StanCorp 2014 KBW Conference Presentation, available at investor.stancorpfinancial.com.


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