Tag Archives: edward o. comitz

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.

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Edward Comitz Named as an Arizona Business Leader in Healthcare Law

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.

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Inaugural Ball to be Held by the Disability Community in D.C.

Two disability advocacy groups, the American Association of People with Disabilities and Disability Power & Pride, have teamed up to host the second Disability Community Inaugural Ball on January 19th at the National Press Club.  The ball is one of many in Washington, D.C. over the weekend to celebrate President Obama’s inauguration.

The fully-accessible Disability Community Inaugural Ball is open to the public, with more than 400 guests expected.  It is also anticipated that members of Congress will attend, possibly including the ball’s honorary committee members, Sen. Dick Durbin, D-Ill., Sen. Tom Harkin, D-Iowa, Rep. Steny Hoyer, D-Md. and Kareem Dale, a disability adviser to President Obama.  Event planners see the ball as an opportunity for people with disabilities to come together as a community, potentially make an impression on Washington, and, of course, to have fun.

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AzMedicine publishes “Can Your Disability Insurer Dictate the Terms of Your Care?” article by Ed Comitz and Michael Vincent

Disability insurance attorney Edward O. Comitz and Michael Vincent, Summer Associate at Comitz | Beethe, had their article “Can Your Disability Insurer Dictate the Terms of Your Care?” published in the Winter edition of AzMedicine, the publication of the Arizona Medical Association.  The article is excerpted below.

Can Your Disability Insurer Dictate the Terms of Your Care?

By Edward O. Comitz, Esq. and Michael Vincent

           Imagine that you are a surgeon who has submitted a disability insurance claim after failed cataract surgery left you with halos, starbursts, and even temporary blindness under bright lighting. While you are dedicated to your profession, you realize that continuing to operate on patients puts them in danger.  Your disability insurance company, however, will not pay your claim.  It insists that you can keep performing surgeries, alleviating any occupational hazards by wearing sunglasses and using matte-finish instruments in the operating room.  This scenario may sound absurd, but it is an actual example of some of the difficulties faced by many doctors seeking legitimate policy benefits.  Fortunately, the surgeon in question had the common sense to cease performing surgeries rather than follow her insurer’s suggestions.  Her decision did affect her financially, as benefits were denied for almost two years, and only paid after litigation ensued.

Insurance company treatment mandates are commonplace and based on their interpretation of the terms of your policy.  In some cases, the insurance company goes so far as to demand surgery, invading your privacy and leaving you with the choice of either undergoing an operation involuntarily, bearing all of the medical risks and financial costs yourself, or waiving your right to collect disability insurance benefits.  The decision can be difficult, but understanding your rights and obligations beforehand can help alleviate much of the worry.

Whether or not insurers can legally condition payment of your disability insurance benefits upon you following their suggested treatments depends on the specific terms in your policy.  The various policy types fall into three general categories: “regular care” policies, “appropriate care” policies, and “most appropriate care” policies.

The oldest policies typically contain provisions conditioning benefits on being “under the regular care and attendance of a physician.”  These “regular care” policies provide the most protection for insureds, as courts have repeatedly found that these provisions only create a duty for the insured to undergo regular monitoring by a physician to determine if the disability persists.  Even if a proposed surgery is usually successful and very low risk, an insurance company cannot force it upon you.  Under a policy requiring only regular care, courts will not enforce any particular course of treatment, no matter how vehemently an insurance company objects. Continue reading AzMedicine publishes “Can Your Disability Insurer Dictate the Terms of Your Care?” article by Ed Comitz and Michael Vincent

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Working with Disability Claim Managers – Know Your Rights and Be Vigilant

Even though disability insurance companies have a duty under Arizona law to give your interests equal consideration to their own, insurers rarely act for the policyholder’s benefit.   Claims benefit managers are frequently taught how to approach disability claimants to get a desired result, usually a denial or termination of benefits.  From our years of experience with the disability insurance industry, we have learned some of the tactics claims personnel use.  The following is a list of strategies to beware of.  Though not every disability claim manager engages in these practices, it is always a good idea for claimants to be vigilant in order to protect their rights under their policy.

  • Treating claims like a unit of production.  Disability insurance companies often don’t care to know how being disabled and filing for benefits affects you personally.  Don’t expect that they will understand or be sympathetic to the personal toll the entire process takes on a claimant, especially a doctor or dentist who has spent years in study and practice to achieve professional success.  To disability insurers, each claim is a unit of production being channeled towards an end goal.
  • Misinterpreting policy provisions.  Disability insurance claims managers are not lawyers, and just like most people, often have trouble properly interpreting complicated insurance policies.  For example, claims personnel might inform an insured that her claim is an “any occupation” policy when in fact it is an “own occupation” policy.
  • Claiming rights that don’t exist under the policy.  Claims managers will also frequently indicate that the disability insurance company can make claimants do certain things or provide certain information that is not actually required under the individual policy.  For instance, an insurer might tell a claimant he needs to complete a detailed daily activity report, when there is actually no such requirement to do so in his policy.  Make sure you know what your policy does and does not actually allow.
  • Acting like your friend.  Employees of disability insurance companies often try to act like your friend or partner in the process, when they are actually channeling your claim towards denial or termination of benefits.  Often, claims managers will call an insured for a friendly chat, all the while peppering the insured with seemingly innocuous questions meant to provide evidence for claim denial.  Policyholders should understand the questions being asked, and not get distracted by the congeniality of the caller.
  • Sending “field investigators” to talk about your claim. Another common practice in the disability insurance industry is to schedule an in-person interview in the claimant’s home with a “field investigator.”  These interviewers will spend hours asking about your symptoms and activities in excruciating detail, taking copious notes and even asking to photograph you.  What they may not make clear is that the field investigator has no authority over the disposition of your claim.  Rather, he or she is a private investigator hired by your insurance company to gather evidence against your claim and provide a starting point for surveillance.

The best way to make sure that these claims management practices aren’t used to take advantage of you when making a claim for disability benefits is to enlist an attorney who knows the tactics used and how to guard against them.  Nevertheless, every insured should understand their insurance company’s approach to claims management and be cautious in their interactions with claims management personnel.

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Phoenix Children with Disabilities Join in Performance of “Cinderella” with Ballet Academy of Arizona

Last Saturday night in Phoenix, the Ballet Academy of Arizona performed before an appreciative crowd of hundreds, and on stage participating in the performance were talented youngsters, many of whom have disabilities. Some of the dancers were in wheelchairs, and some were mentally challenged. As parent Kathy Suszcezwicz told ABC-15, “It takes so much just [for them] to gain the basic skills to walk, sit and stand up.”

“It’s a life changing experience I’ll never forget, and they’ll never forget,” says Suzy Richardson, mother of one of the children. “They’re being able to shine, to dance, to move, to show what they are with everybody else inclusive; not special, not put aside, but together.” Comitz | Beethe applauds the hard work of these children with disabilities and their instructors.

The Ballet Academy of Arizona is a children’s performing arts non-profit organization.

Last Saturday night in Phoenix, the Ballet Academy of Arizona

The attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Tucson, Scottsdale, Sedona, Flagstaff, Lake Havasu City, Yuma, and Prescott. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.

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President Obama Proclaims October 14, 2011 Blind Americans Equality Day

THE WHITE HOUSE

Office of
the Press Secretary

FOR
IMMEDIATE RELEASE

October 14,
2011

THE
WHITE HOUSE

Office of the Press Secretary

For Immediate Release October 14, 2011

BLIND AMERICANS EQUALITY DAY, 2011

– – – – – – –

BY THE PRESIDENT OF THE UNITED STATES OF
AMERICA

A PROCLAMATION

Generations of blind and visually impaired Americans have dedicated their passion and skills to enhancing our national life — leading as public servants, penning works of literature, lending their voice to music, and inspiring as champions of sport. On Blind Americans Equality Day, we celebrate the achievements of blind and visually impaired Americans and reaffirm our commitment to advancing their complete social and economic integration.

My Administration is dedicated to ensuring Americans with disabilities have every opportunity to reach their full potential. Last year, I signed the Twenty-First Century Communications and Video Accessibility Act to set new standards that enable people living with disabilities to access broadband, digital, and mobile innovations. To help level the playing field for employment, we are working to improve the Federal Government’s compliance with Section 508 of the Rehabilitation Act. Making  electronic and information technology 508 compliant will give applicants with disabilities a fair chance and allow employees with disabilities to use necessary tools while on the job. By taking these steps, my Administration reaffirms its pledge to openness by making sure that people with disabilities can better access all the information the Federal Government has placed online.

This year also marks the 75th anniversary of the passage of the Randolph-Sheppard Act. For decades, the legislation has provided openings for blind Americans to work as vendors on Federal property, creating meaningful entrepreneurial opportunities and enabling them to contribute to our economy. These jobs have enriched the lives of those participating in the Randolph-Sheppard program and enhanced public understanding of blindness for those who have interacted with the program’s vendors.

Though we have made progress in the march to equality for the blind and those with low vision, there is still more work to be done. In addition to improving access to technology and employment opportunities, this January, I signed the Pedestrian Safety Enhancement Act. This landmark legislation requires electric and hybrid car manufacturers to add sounds to alert all pedestrians to the presence of these unusually quiet vehicles. These provisions will help increase the safety and independence of blind and visually impaired Americans.

By joint resolution approved on October 6, 1964 (Public Law 88-628, as amended), the Congress designated October 15 of each year as “White Cane Safety Day” to recognize the contributions of Americans who are blind or have low vision. Today, let us recommit to forging ahead with the work of perfecting our Union and ensuring we remain a Nation where all our people, including those living with disabilities, have every opportunity to achieve their dreams.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, do hereby proclaim October 15, 2011, as Blind Americans Equality Day. I call upon public officials, business and community leaders, educators, librarians, and Americans across the country to observe this day with appropriate ceremonies, activities, and programs.

IN WITNESS WHEREOF, I have hereunto set my hand this fourteenth day of October, in the year of our Lord two thousand eleven, and of the Independence of the United States of America the two hundred and thirty-sixth.

BARACK OBAMA

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Don’t Toss the Policy: Important Documents for a Disability Insurance Claim

If you are a doctor, dentist, or other professional considering filing a disability insurance claim, there are some key documents you should collect and keep in order to properly understand and document your claim, including:

1. Your disability insurance policy

2. The insurance application

3. Notes or letters from meetings with the insurer’s sales agents

4. Notes of telephone conversations with your insurance company employees

5. Letters to and from your insurance company

6. Emails to and from your insurance company

7. Medical records

8. Billing records from your practice

9. A daily pain journal, if necessary

Make sure to keep all of your disability insurance papers and notes in an organized file, and if you have to file a claim, contact an experienced attorney who can help you interpret your policy, present your claim, and communicate with your insurer.

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Insurance Bad Faith: Different Standards for Different States – Part 7 (Washington)

A disability insurance company may be subject to a lawsuit for bad faith when it wrongly denies a claim.  There are differences from state to state in what constitutes insurer bad faith. In previous posts in this series, we have outlined the first-party insurance bad faith law of ArizonaCaliforniaColorado, NevadaNew Mexico and Texas.  In today’s post, we outline the standards applied in the State of Washington.

Insurance companies who use unfair claim settlement practices can be found to have committed bad faith under Washington’s tort law or under the Washington Consumer Protection Act.  According to Washington law, an insurance company’s violation of the consumer protection statute constitutes an automatic unfair trade practice violation, and also a breach of the duty of good faith and fair dealing. If a policyholder brings a claim under the Consumer Protection Act, he or she will have to show economic (monetary) damages, but if he or she brings a tort bad faith claim, the injury need not be economic and can include emotional distress or other personal injuries.

The Statutes: R.C.W. 48.01.030 and Wash. Admin. Code § 284-30-330

The Rules: Washington regulations define the following as unfair or deceptive practices for settlement of insurance claims:

  • Misrepresenting pertinent facts or policy provisions.
  • Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies.
  • Refusing to pay claims without conducting a reasonable investigation.
  • Failing to affirm or deny coverage within a reasonable time after fully completed proof of loss documentation has been submitted.
  • Not attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear.
  • Compelling an individual disability claimant to initiate or submit to litigation, arbitration, or appraisal to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in such actions or proceedings.
  • Attempting to settle a claim for less than the amount to which a reasonable person would have believed he or she was entitled by reference to written or printed advertising material accompanying or made part of an application.
  • Asserting to a disability insurance claimant that the company has a policy of appealing arbitration awards in favor of insureds for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration.
  • Delaying the investigation or payment of claims by requiring a first party claimant or his or her physician to submit a preliminary claim report and then requiring subsequent submissions which contain substantially the same information.
  • Failing to promptly settle claims, where liability has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
  • Failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement.
  • Failing to expeditiously honor drafts given in settlement of claims.
  • Failing to adopt and implement reasonable standards for the processing and payment of claims after the obligation to pay has been established—normally within 15 business days after receipt by the insurer or its attorney of properly executed releases or other settlement documents.
  • Negotiating or settling a claim directly with any claimant known to be represented by an attorney without the attorney’s knowledge and consent.

The Tort Law Standard:  An insurance company’s actions can be considered bad faith if its breach of the insurance contract was unreasonable, frivolous, or unfounded.

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Insurance Bad Faith: Different Standards for Different States – Part 5 (New Mexico)

Over the past several days, we have been outlining the different standards that apply from state to state in determining whether a disability insurance company has acted in bad faith in wrongly denying a claim.  Previous posts have outlined the standards for ArizonaCaliforniaColorado, and Nevada.  Today we look at the statutes and tort law of New Mexico.

New Mexico created a statute governing insurance company practices, called the Trade Practices and Frauds Act, in order to promote ethical settlement practices within the insurance industry.  Anyone who has suffered damages as a result of a violation of that statute by a disability insurance company can bring an action to recover his or her damages.  A policyholder can also bring a suit based on the same wrongful conduct under New Mexico’s tort law.

The Statute:  N.M. Stat. § 59A-16-20

The Rules: Any and all of the following practices by an insurance company are defined as unfair and deceptive practices and are prohibited:

  • Falsely representing pertinent facts or policy provisions relating to coverages at issue to insured.
  • Failing to acknowledge and act reasonably promptly upon communications with policyholders.
  • Failing to have reasonable standards in place for prompt disability claim processing and investigation.
  • Failing to affirm or deny coverage of claims of insureds within a reasonable time after proof of loss requirements under the policy have been completed and submitted.
  • Not attempting in good faith to come to prompt, fair and equitable settlements of claims in which the disability insurance company’s liability has become reasonably clear.
  • Compelling insureds to institute a lawsuit to recover amounts due under their policy by offering substantially lower amounts than those ultimately recovered when the insureds have made claims for amounts reasonably close to the amounts they ultimately recover at trial.
  • Attempting to settle a disability claim for less than the amount to which a reasonable person would have believed he was entitled by reference to written or printed ads accompanying or made part of a disability insurance application.
  • Trying to settle claims on the basis of an application that was altered without the policyholder’s knowledge or consent.
  • Delaying the investigation or payment of claims by requiring unnecessary, duplicative information.
  • Failing to promptly provide an insured a reasonable explanation of the basis the insurance company relied on to deny a disability claim.
The Tort Law Standard:  A disability insurance company that fails to pay a claim has acted in bad faith where its reasons for denying or delaying payment on the disability claim are frivolous or unfounded.

In our next blog post about Insurance Bad Faith, we will outline the standards that apply in the State of Texas.

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