Tag Archives: Arizona disability insurance attorney

Comitz | Beethe Attorney Ed Comitz Posts CE Course on Dentaltown

Ed Comitz’s Continuing Education course “Disability Insurance Roulette: Why is it So Hard to Collect on My Policy” is now available through Dentaltown.  This CE is an electronically delivered, self-instructional program and is designated for 2 hours of CE credit.  In this course, Ed discusses why it is so difficult for dentists to collect disability benefits and how to avoid the most common mistakes made by dentists when filing disability claims.  Ed also covers the key provisions to look for in disability insurance policies and provides an overview of the disability claims process.  Finally, the course discusses how disability insurance claims are investigated and administered, and identifies common strategies used by insurance companies to deny claims.

Information on how to register can be found here

 

For more information regarding what to look for in a policy, see this podcast interview where Ed Comitz discusses the importance of disability insurance with Dentaltown’s Howard Farran.

Share

Can Your Disability Insurance Company Dictate The Medical Treatment You Must Receive To Collect Benefits? Part 4

Care Dictation Provisions

Throughout this series of posts we’ve addressed the increasingly restrictive medical care provisions in disability insurance policies.  In Part 1, we discussed the evolution of the care standard and its effect on an insured’s ability to collect benefits and control their own medical treatment.  In Part 2 we looked at the “regular care” standard, which places no obligation on the insured to undergo any unwanted medical treatment.  In Part 3 we looked at the “appropriate care” and “most appropriate care” standards, which require much more vigilance on the part of policyholders, because they must be prepared at any time to establish that the treatment they are receiving is justified under the circumstances.  In this final post, we are going to look at the most aggressive and intrusive language that has been adopted by insurance companies in an effort to dictate the care of their policyholders.

Here is an example of a very strict care provision, taken from a Great West policy:

Regular Care of a Physician means personal care and treatment by a qualified Physician, which under prevailing medical standards is appropriate to the condition causing Total Disability or Residual Disability.  This care and treatment must be at such intervals as will tend to lead to a cure, alleviation, or minimization of the condition(s) causing Total Disability or Residual Disability and which will lead to the Member’s return to the substantial and material duties of his own profession or occupation or maximum medical improvement with appropriate maintenance care.

Clearly, this provision was designed with one goal in mind:  to give the insurer nearly unlimited power to scrutinize a policyholder’s course of treatment, including the ability to insist that any given procedure is necessary to cure or minimize the disability and maximize medical improvement.  It is easy to see how an insurer might invoke this provision to assert its control over the medical decision making of their policyholder and use the leverage of benefit termination and claims denial to dictate their treatment.

Imagine that you are a surgeon with a herniated disc in your cervical spine, and that your policy contains the provision cited above.  Your insurer insists that a fusion of the surrounding vertebra is the procedure most likely to alleviate your disability. Your doctor disagrees, recommending a more conservative course of treatment, such as physical therapy, modified activity and medication, such as muscle relaxants.  Your doctor also warns you that if you have the surgery, you will experience reduced mobility and risk adjacent segment degeneration.  However, your disability benefits are your only source of income.  Fearing a claim denial, you agree to the procedure despite your doctor’s concerns.  This results in a no-lose scenario for the insurer.

The best case scenario, from your insurer’s perspective, is that the surgery (for which you bore all the risk both physically and financially) is successful and you are no longer disabled.  At worst, the procedure fails and the insurer merely has to pay the benefits it was obligated to pay to you in the first place.  For you, however, an unsuccessful procedure can mean exacerbation of your condition, increased pain, and prolonged suffering.  It is therefore vital that you understand your rights under your policy.

Insurers are risk-averse by nature, and disability insurance is no different.  Modern disability insurance policies, and particularly the medical care provisions, are designed to minimize the financial risk to the insurer. Insurers place an enormous burden on claimants to prove that their course of treatment meets the rigorous standards in their policy. Though stringent policy language can make it significantly more difficult to obtain the benefits you are entitled to, it does not strip you of your right to make your own medical decisions.

In order to preserve your medical autonomy in the disability claims process, you must become familiar with the details of your policy before filing a claim.  Understanding the terms of your policy—including the care provision in your policy—is critical to successfully navigating a disability claim.  You need to be familiar with your policy’s care requirements from the outset, so that you can communicate effectively with your physician to develop a plan of treatment that you are comfortable with and that comports with the terms of your policy.

Even if you have a basic understanding of your rights under you policy, it can be daunting to deal with an insurer that is aggressively seeking to dictate your medical care.  In some cases, you may be forced to go to court to assert your right to make your own medical decisions—particularly if your policy contains one of the more recent, hyper-restrictive care provisions like the Great West provision above.  Insurers know this, and they also know that most claimants are in no position to engage in a protracted court battle over whether they are receiving appropriate care.  However, simply submitting to the medical mandates of your insurer to avoid the stresses and costs associated with litigation can have drastic consequences, depending on the nature of the medical care you are being asked to submit to.  If you should find yourself in this difficult position, you should contact an experienced disability insurance attorney.  He or she will be able to inform you of your rights under your policy and help you make an informed decision.

 

Share

Ed Comitz selected as an Arizona Business Leader in 2017

abl2017-22017-eoc-2-scan

 

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.”

Share

Ed Comitz Named as Top Lawyer in Field of Insurance Law

untitled

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.

Share

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.

Share

Alzheimer’s: Is there a Helpful Drug on the Horizon?

Alzheimer’s disease is a serious disability that can dramatically impact a physician or dentist’s ability to practice.  In this post, we will be looking at some of the risk factors associated with Alzheimer’s, some of the signs that may indicate the onset of Alzheimer’s, and some of the proposed methods of treating Alzheimer’s.

Risk Factors

Alzheimer’s is a form of dementia that affects memory, thinking, and behavior.  There are three primary risk factors for Alzheimer’s:

  1. Age: Most people that have Alzheimer’s are 65 or older, and the likelihood of developing Alzheimer’s doubles every five years after age 65.
  1. Heredity: Scientists have identified certain “risk” genes that can contribute to the risk of developing Alzheimer’s. Amyloid precursor protein (APP), presenilin-1 (PS-1), and presenilin-2 (PS-2) are proteins that directly cause Alzheimer’s, although “deterministic” Alzheimer’s occurs in only 5% of cases.  APOE-e4 is another gene that scientists believe may be a factor in 20 to 25% of cases, although they are not sure precisely how it increases the risk.
  1. Family History: People who have parents, siblings, or even children with the disease are more likely to have Alzheimer’s. The risk also increases as more family members develop the disease.

Warning Signs

The Alzheimer’s Association lists 10 warning signs that may indicate the onset of Alzheimer’s: Continue reading Alzheimer’s: Is there a Helpful Drug on the Horizon?

Share

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.

Share

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.

Share

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.

Share

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.

Share