Aetna has arranged to sell its group life and disability benefits to The Hartford for $1.45 billion dollars in cash. While group life and disability insurance were a small portion of Aetna’s business (about $2 million in premiums for 2016, compared to The Hartford’s $8.3 million in premiums at the end of the third quarter), this transaction will allow The Hartford the become second largest group life and disability insurer, behind MetLife. The Hartford will also obtain digital assets from Aetna, including absence, claims management, and data analytics systems, as well as a customer portal. And, following the sale, Aetna will offer The Hartford’s group life and disability products through Aetna’s sales force. The Hartford has also agreed to reinsure Aetna’s book of group life and disability insurance, on an indemnity basis.
While an Aetna press release states the two companies will work together to support their mutual customers, and the majority of Aetna’s 1,800 employees who support the acquired business will transfer to The Hartford, there are no details yet on how Aetna’s plans will be administered going forward, including for those already on claim.
The acquisition is expected to close in November 2017.
Aetna, The Hartford Signs Agreement to Acquire Aetna’s U.S. Group Life and Disability Business, Oct. 23, 2017
The Hartford, The Hartford to Acquire Aetna’s U.S. Group Life and Disability Business, Special Presentation Webcast, Oct. 23, 2017
Japsen, Bruce, Aetna To Sell Group Life Business To Hartford for $1.4B, Oct. 23, 2017, 9:04 a.m.
Livingston, Shelby, Aetna to shed its life and disability insurance businesses for $1.5 billion, Modern Healthcare, Oct. 23, 2017
Otto, Nick, The Hartford to acquire Aetna’s life, disability business, Oct. 23, 2017, 2:39 p.m.,
Reuters, Hartford to buy Aetna US life and disability unit for $1.45 billion, CNBC, Oct. 23, 2017, 9:16 a.m.
Reuters, The Hartford to Buy Aetna Group Life, Disability Benefits Business for $1.45 Billion, Insurance Journal, Oct. 23, 2017
SEAK, Inc.’s 14th Annual Non-Clinical Careers for Physicians Conference will be held on October 21 -22, 2017 in Chicago, Illinois. The conference is intended for physicians looking to explore careers outside the clinical setting.
Many doctors and dentists find themselves unable to practice, whether due to a disability, fatigue, burnout, loss of opportunity, wanting more control over their schedule, hope of financial gain, or just the desire to try a different career path or become an entrepreneur. The 375+ attendees at the conference will range from interns and residents to veteran physicians in their 70s. The conference aims to show physicians that switching to a non-clinical career is an opportunity with financial potential, and “is in fact a step forward, not a step backwards.” Attendees at the conference will network, meet with employers and recruiters, attend workshops and presentations and participate in one-on-one mentoring with physicians who have successfully made the transition to non-clinical careers. Several of the presenters have not only moved out of the clinical practice, but are also experienced life coaches dedicated to guiding other physicians into new careers. Sessions discuss opportunities for physicians with insurance companies, medical device companies, the pharmaceutical industry, contract research organizations, healthcare IT and medical informatics companies, and in education as well as in the consulting, medical administration, patient safety/quality, medical writing, and entrepreneurial fields.
Returning speakers include Gretchen M. Bosack, MD, who has transitioned to the Chief Medical Director of the Securian Financial Group and is also an accomplished public speaker; Rishi Anand, MD, who transitioned to the director of the Electrophysiology Laboratory at Holy Cross Hospital in Ft. Lauderdale, Florida, as well as serving as a medical legal consultant and expert witness, and a successful real estate investor; and Savi Chadha, MD, MPH, a medical science liaison with Tardis Medical Consultancy. The opening speaker, Philippa Kennealy, MD, MPH, CPCC, PCC, is president of The Entrepreneurial MD and the Physician Odyssey Program, where she helps physicians further their non-clinical careers.
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.
Chronic pain is often difficult to diagnose and treat. Consequently, those who suffer from chronic pain typically must also deal with a significant amount of stress, due to repeated failed treatments, numerous medical appointments, interruption of work and enjoyable activities, and the inability of their friends or family to understand their physical limitations. This can, in turn, cause or worsen depression. When depression occurs alongside chronic pain, it can make dealing with and treating the pain even harder.
Chronic Pain Disorders Associated with the Co-Occurrence of Depression
While mental health conditions, including depression, can often be disabling in and of themselves, they are unfortunately also quite common in those suffering from chronic pain. Depression is more likely to co-occur with certain conditions, such as:
- Back Pain
- Neck Pain
- Joint Pain
Studies show that rates of depression are high in residents and medical students (15%-30%) than rates in the general population, and the risk of depression continues throughout a physician’s career. According to a British study, 60% of dentists reported being anxious, tense, or depressed.
Dentists, doctors, and other medical professionals place extreme amounts of pressure on themselves because the stakes of their professions are so high. In addition to perfectionism and self-criticism, other predictors of depression in doctors include: lack of sleep, stressful interactions with patients and staff, dealing with death, constant responsibility, loneliness, and making mistakes.
Often practitioners work through both chronic pain and psychiatric disorders for some time before acknowledging their disability or seeking adequate treatment. In the case of depression, this can be due in part to the social stigma that surrounds it. For all of these reasons, depression may go undiagnosed or seem less of an immediate concern to those suffering from chronic pain. However, if you are experiencing symptoms of depression and chronic pain, studies show that it is important to treat both, because chronic pain can become much more difficulty to treat if the depression is allowed to progress unchecked.
Chronic Pain and Depression—Worse Together
Facing a long-term or permanent disability can trigger depression—this is especially understandable for doctors or dentists who have put years into medical school and establishing their careers, only to become disabled and have to step away from a profession that has become a significant part of their identity. Depression can also precede chronic pain. For example, several studies have examined the link between depression before the onset of back-pain.
Regardless of which came first, together they are formidable to treat. Major depression is thought to be four times greater in people with chronic back pain than those in the general population, and studies show that individuals suffering from both chronic back pain and depression experienced a greater degree of impairment than those with either depression or back pain alone.
Treatments for Depression
Focusing solely on pain management can prevent both the patient’s and treating physician’s ability to recognize that a psychiatric disorder is also present. Yet, even with correct diagnoses, both issues can be difficult to treat together. For instance, those who suffer from both chronic pain and mental illnesses can have a lower pain threshold as well as increased sensitivity to medication side-effects. Some treatments that have proved successful in addressing depression in those with chronic pain include:
- Cognitive-behavioral therapy (CBT)
- Psychodynamic therapy (talk therapy)
- Relaxation or meditation training
Symptoms of Depression
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Trouble falling asleep or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Trouble concentrating
- Feeling bad about yourself, or that you are a failure or have let yourself or others down
- Thoughts that you would be better off dead, or hurting yourself in some way
Chronic pain sufferers who recognize any of the above-referenced symptoms in themselves should talk to their doctor to address these serious issues.
 Robert P. Bright, MD, Depression and suicide among physicians, Current Psychiatry, April 10, 2011.
 William W. Deardorff, PHD, ABPP, Depression Can Lead to Chronic Back Pain, Spine-health.com, Oct. 15, 2004, http://www.spine-health.com/conditions/depression/depression-can-lead-chronic-back-pain.
 William W. Deardorff, PhD, ABPP, Depression and Chronic Back Pain, Spine-health.com, Oct. 15, 2004, http://www.spine-health.com/conditions/depression/depression-and-chronic-back-pain.
 Celeste Robb-Nicholson, M.D., The pain-anxiety-depression connection, Harvard Health Publications, http://www.health.harvard.edu/healthbeat/the-pain-anxiety-depression-connection.
 Anxiety and Depression Association of America, Chronic Pain, https://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/chronic-pain.
In a previous post, we discussed the importance of how your policy defines the key term “total disability,” and provides several examples of “total disability” definitions. The definition of “total disability” in your policy can be good, bad, or somewhere in-between when it comes to collecting your benefits.
Policies with “true own occupation” provisions are ideal. Here’s an example of a “true own occupation” provision:
Under this type of provision, you are “totally disabled” if you can’t work in your occupation (for example, you can no longer perform dentistry). This means that you can still work in a different field and receive your benefits under this type of policy.
Insurance companies often try to make other policies look like true own occupation policies, and include phrases like “own occupation” or “your occupation,” but then tack on additional qualifiers to create more restrictive policies.
One common example of a restriction you should watch out for is a “no work” provision. Although these provisions can contain the phrase “your occupation” they only pay total disability benefits if you are not working in any occupation. Here’s an example from an actual policy:
As you can see, under this type of provision, you cannot work in another field and still receive benefits. This can be problematic if you do not have sufficient disability coverage to meet all of your monthly expenses, as you’re not able to work to supplement your income.
A “no work” provision is something that is relatively easy to recognize and catch, if you read your policy carefully. Recently, we have come across a definition of “total disability” that is not so easy to spot, but can dramatically impact you ability to collect benefits. Here’s an example, taken from a 2015 MassMutual policy:
At first glance, this looks like a standard “own-occupation” provision—in fact, it is entitled “Own Occupation Rider.” But if you take the time to read it more closely, you’ll notice that the second bullet point requires you to be working in another occupation in order to receive “total disability” benefits.
Obviously, this is not a policy you want. If you have a severely disabling condition, it may prevent you from working in any occupation, placing you in the unfortunate position of being unable to collect your benefits, even though you are clearly disabled and unable to work in any capacity. Additionally, many professionals have limited training or work history outside their profession, so it can be difficult for them to find alternative employment or transition into another field—particularly later in life.
These “work” provisions appear to be a relatively new phenomenon, and are becoming increasingly more common in the newer policies being issued by insurance companies. It is crucial that you watch out for these “work” provisions and make sure to read both the policies definition of “own-occupation” and “total disability.” While many plans contain the phrase “own-occupation”, including this example, they often aren’t true own-occupation policies and you shouldn’t rely on an insurance agent to disclose this information. Oftentimes, your agent may not even realize all of the ramifications of the language and definitions in the policy that they are selling to you.
Lastly, you’ll also note that this particular provision was not included in the standard “definitions” section of the policy, but was instead attached to the policy as a “rider,” making it even harder to spot. It’s important to remember that many definitions and provisions that limit coverage are contained in riders, which typically appear at the end of your policy. Remember, you should read any policy from start to finish before purchasing.
Many disability claimants suffering from chronic, intense pain are surprised and disheartened when their reported pain levels are received with skepticism by their insurance company. Since pain is a subjective feeling, treating doctors typically ask patients to self-report their pain on a scale of 0-10, so that they can diagnose and treat the pain. Unfortunately, most insurance companies are unwilling to accept self-reported pain levels and will often try to downplay the severity of the claimant’s pain, citing a lack of objective evidence.
Recently, researchers have developed a technology called functional MRI scans, or fMRIs, for short, which may provide a new way to objectively verify the existence of pain. In this post, we will examine this technology and discuss how it might be used in the context of disability claims.
What is an fMRI?
fMRI scanning is a noninvasive technique used by doctors to map and measure brain activity. More specifically, fMRIs are used to measure and observe increases in MR signal caused by neural activity in the brain. The fMRI data is then analyzed to determine which parts of the brain were active during the scan. The data is then compared to known neurological signatures, or “biomarkers,” to determine if there are any correlations between the neural activity in the brain and the symptoms reported by the patient (such as chronic pain).
The Use of fMRI Scans to Prove Pain
Recently, a number of companies and researchers are focusing on using fMRI scans to produce objective evidence of pain. For instance, Dr. Joy Hirsch, a professor at the Yale School of Medicine, claims to have developed a test that is capable of distinguishing real, chronic pain from imagined pain.
fMRI scans are also now being used to support the cases of claimants in disability cases. For example, a woman in New York recently used an fMRI scan to convince her insurer, after two years of litigation, that her disability claim never should have been denied. An fMRI scan was also recently used in the case of Carl Koch, a truck driver from Arizona who suffered severe burns when the hose of his tanker broke loose and sprayed him with molten tar. Mr. Koch visited Dr. Hirsch, who used functional brain mapping to conclude that Mr. Koch’s pain was real. When the judge ruled that Dr. Hirsch’s testimony would be admissible at trial, the case settled for $800,000 – an amount ten times higher than the company’s original offer.
What the Skeptics Say
The use of fMRI scans to prove pain remains controversial. Some critics argue that the techniques being used in litigation have little support in existing publications. Others, such as Tor Wager, a professor of psychology and neuroscience at UC Boulder, contend that the sample size in available studies is too small. Proponents of fMRI refute both of these claims, arguing that a number of credible studies support the validity of their methods.
The Future of fMRI Scans in Disability Cases
It’s easy to see how fMRI scans could prove useful in a disability claim. For example, many dentists suffer from musculoskeletal disorders, particularly in their spines, that cause chronic, debilitating pain. However, as noted above, these types of claims can be particularly difficult, because many insurance companies refuse to accept a claimant’s self-reported pain levels and limitations. Co-workers, family, and friends can provide statements describing how the dentist’s pain is affecting his performance at work and his quality of life, but once again, insurance companies will typically similarly claim that such statements are “objectively verifiable” evidence of the pain. Sometimes a cervical or lumbar MRI can identify potential causes for the pain, and/or a functional capacity exam (FCE) can help document the limitations the pain is causing—but these types of reports are also commonly challenged by insurance companies intent on denying benefits.
In such a case, an fMRI scan illustrating the doctor’s pain might serve as an additional, objectively verifiable method of establishing the existence of chronic pain. Whether or not insurance companies are willing to accept fMRIs as reliable evidence of pain remains to be seen, and will likely depend, in large part, on how willing courts are to accept fMRIs as admissible evidence of pain. If, in the future, this technology continues to develop and become more precise, and courts and juries demonstrate a willingness to accept fMRIs as proof of pain, fMRIs may eventually be enough to convince insurance companies to accept legitimate disability claims without ever setting foot in a courtroom.
- UC San Diego Sch. of Med., What is fMRI?, available at http://fmri.ucsd.edu/Research/whatisfmri.html.
- Sushrut Jangi, Measuring Pain Using Functional MRI, The New England Journal of Medicine, available at http://blogs.nejm.org/now/index.php/9863/2013/04/10/.
- Steven Levy, Brain Imaging of Pain Brings Success to Disability Claim, EIN Presswire (June 29, 2016), available at http://www.einpresswire.com/article/333249721/brain-imaging-of-pain-brings-success-to-disability-claim.
- Kevin Davis, Personal Injury Lawyers Turn to Neuroscience to Back Claims of Chronic Pain, ABA Journal (Mar. 1, 2016), available at http://www.abajournal.com/magazine/article/personal_injury_lawyers_turn_to_neuroscience_to_back_claims_of_chronic_pain.
In today’s pharmaceutical market there are countless prescription drugs marketed to people suffering from disabling conditions, and many of these drugs promise breakthrough relief not offered by their competitors. Individuals suffering from chronic pain and mental health disorders such as anxiety, PTSD, depression and bipolar must often take potent drugs for prolonged periods of time to get relief from their symptoms. But the search for relief can be incredibly frustrating – every person responds differently to the same drugs, and oftentimes powerful side effects can overshadow any relief.
For an individual suffering from the chronic and disabling pain brought on by severe spinal stenosis, there are several forms of treatment available – many of which are non-invasive. If other non-invasive treatments are unsuccessful, suffering through the side effects of several drugs in search of relief can be demoralizing. Powerful opioids can cause severe nausea, vomiting, dizziness, and/or constipation in certain individuals. The compounding effects of trying several different drugs can have a significant effect on one’s physical and mental health.
Recently, however, a genetic testing company has developed a simple test that will help countless individuals avoid dealing with unwanted side effects while cycling through different medications in their quest for relief.
Genesight has developed breakthrough genetic tests for both narcotic analgesics (pain medications) and psychotropic medications (treating mental health disorders). By taking a simple cheek swab, the company is able to analyze your DNA and determine which medications are match for your specific genetic profile. A clinical study of Gensight’s testing and analysis showed that patients were twice as likely to respond to the recommended medication.
This testing will likely be welcome news among those for whom relief is elusive. For many individuals suffering from disabling conditions, medications are very rarely the magic bullet that brings complete relief. Symptoms may be so severe that no drug will ever be one hundred percent effective. More often, relief means alleviation of one’s symptoms just enough to get through the day without interminable pain or crippling anxiety while suffering only the more mild side effects. Genesight’s testing may offer hope for these individuals – people who will likely never be able to return to their previous career or their own occupation, but are in search of just enough relief from their symptoms to lead and enjoy a normal life.
Ninth Circuit Determines That Persons Who Can’t Sit for More than Four Hours Can’t Perform Sedentary Work
In a previous post, we summarized the five exertion levels (sedentary work, light work, medium work, heavy work, and very heavy work), as defined by the Dictionary of Occupational Titles (DOT), and discussed why they matter in the context of disability claims. Essentially, these exertion levels function as broad classifications that are used to categorize particular jobs and occupations. The physical requirements under each exertion level increase as you move up from level to level, with sedentary work requiring the least physical exertion and very heavy work requiring the most physical exertion.
If you have an “own occupation” policy, these exertion levels will likely not come into play, because the terms of your policy will require your insurer to consider the particular duties of your specific occupation, as opposed to the broader requirements of the various exertion levels. However, if you have an “any occupation” policy, which requires you to establish that your disability prevents you from working in any capacity, your insurer will likely seek to determine your restrictions and limitations at the outset of your claim, using claim forms or possibly a functional capacity evaluation (FCE). Once they have done so, they will then likely seek to fit you into one of the five exertion levels listed above and have their in-house vocational consultant provide them with a list of jobs that you can perform given your limitations.
Not surprisingly, your insurer will generally try to fit you into the highest category possible, and then argue that you can perform all of the jobs at that exertion level, and all jobs classified at a lower exertion level. Typically, someone suffering from a disabling condition can easily establish that they cannot perform medium, heavy, or very heavy work, so, in most cases, the insurer will be trying to establish that you can perform light work, or sedentary work, at the very least.
As you might expect, one of the key differences between sedentary and light work is that sedentary work mostly involves sitting, without much need for physical exertion, whereas light work involves a significant amount of walking and standing, in addition to other physical requirements, such as the ability to push or pull objects and the ability to operate controls. Given the low physical demands of sedentary work, it can often be difficult to establish that you cannot perform sedentary work. This can be problematic, because there are many jobs that qualify as sedentary work. However, if you have a disability that prevents you from sitting for extended periods of time, the very thing that makes sedentary work less physically demanding—i.e. the fact that you can sit during the job—actually ends up being the very reason why you cannot perform sedentary work.
While this is a common sense argument, many insurance companies refuse to accept it and nevertheless determine that claimants who cannot sit for extended periods of time can perform sedentary work. However, the Ninth Circuit Court of Appeals recently held in Armani v. Northwestern Mutual Life Insurance Company that insurers must consider how long a claimant can sit at a time when assessing whether they can perform sedentary work.
Avery Armani was a full-time controller for the Renaissance Insurance Agency who injured his back on the job in January 2011. He eventually stopped working as a result of the pain from a disc herniation, muscle spasms, and sciatica. Multiple doctors confirmed that Avery was unable to perform the duties of his job, which required him to sit for approximately seven hours per day. In July 2011, Northwestern Mutual classified Avery’s occupation as “sedentary” and approved his claim under the “own occupation” provision of his employer-sponsored plan.
Despite regular statements to Northwestern Mutual from his doctor that he could only sit between two and four hours a day and must alternate between standing and sitting every thirty minutes, Avery’s disability benefits were terminated in July 2013. Northwestern Mutual’s claims handler identified three similar positions in addition to Avery’s own position that he could perform at a “sedentary” level, and determined that his condition no longer qualified as a disability under his policy.
When his benefits were terminated, Avery sued Northwestern Mutual. After several years, his case ultimately reached the Ninth Circuit Court of Appeals. In resolving the case, the Ninth Circuit held that an individual who cannot sit more than four hours in an eight-hour workday cannot perform “sedentary” work that requires “sitting most of the time.” In reaching its conclusion, the Ninth Circuit cited seven other federal courts that follow similar rules, including the Second Circuit Court of Appeals, the Sixth Circuit Court of Appeals, the District of Oregon, the Central District of California, the Northern District of New York, the Southern District of New York, and the District of Vermont.
While this case is not binding in every jurisdiction, it does serve to reinforce the common sense argument that a claimant who cannot sit for extended periods of time due to his or her disability cannot perform sedentary work. Additionally, though this rule was created in the context of a disability insurance policy governed by ERISA, the court did not qualify its definition or expressly limit its holding to cases involving employer-sponsored policies. Accordingly, in light of this recent ruling, it would be reasonable to argue that a court assessing an “own occupation” provision of an individual policy should similarly consider whether sitting for extended periods of time is a material and substantial duty of the insured’s occupation. If it is, and the insured has a condition that prevents him or her from sitting for more than four hours of a time—such as deep vein thrombosis (DVT) or chronic pain due to degenerative disc disease—then the insured arguably cannot perform his or her prior occupation and is entitled to disability benefits.
In short, the Armani case is noteworthy because its reasoning could potentially be applied to not only ERISA cases, but also disability cases involving individual policies and occupations—such as oral surgeon, endodontist, periodontist, attorney, accountant, etc.—that require the insured to sit for long periods of time in order to perform the occupation’s material duties. It will be interesting to see if, in the future, courts expand the Armani holding to cases involving individual policies outside of the ERISA context.
As we have discussed in previous posts, musculoskeletal disorders are very common among dentists due to the repetitive movements and awkward static positions required to perform dental procedures. Unum, one of the largest private disability insurers in the United States, recently released statistics showing an increase in the filing of musculoskeletal disability claims over the past 10 years.
According to Unum’s internal statistics, long term disability claims related to musculoskeletal issues have risen approximately 33% over the past ten years, and long term disability claims related to joint disorders have risen approximately 22%. In that same period of time, short term disability claims for musculoskeletal issues have increased by 14%, and short term disability claims for joint disorders have risen 26%.
This trend may lead to Unum directing a greater degree of attention towards musculoskeletal claims as the volume of these claims continues to increase. Musculoskeletal claims are often targeted by insurance companies for denial or termination because they are easy to undercut—primarily due to the limitations of medical testing in this area. For instance, it can be difficult to definitively link a patient’s particular subjective symptoms to specific results on an MRI, and other tests, such as EMGs, are not always reliable indicators of the symptoms that a patient is actually experiencing. Insurers also typically conduct surveillance on individuals with neck and back problems in an effort to collect footage they can use to deny or terminate the claim. While such footage is usually taken out of context, it can be very difficult to convince the insurance company (or a jury) to reverse a claim denial once the insurer has obtained photos or videos of activities that appear inconsistent with the insured’s disability.
As we have noted in a previous post, Unum no longer sells individual disability insurance policies, so its disability insurance related income is now limited to the premiums being collected on existing policies. Because benefit denials and termination are the primary ways insurers like Unum can continue to profit from a closed block of business, and musculoskeletal claims are on the rise, Unum may begin subjecting this type of claim to even higher scrutiny.
Dentistry is not an easy profession. The clinical aspects of dentistry are physically and emotionally demanding. Performing repetitive procedures and holding static postures for prolonged periods of time can leave dentists feeling mentally drained, sore and fatigued. And given the frequent exposure to patient anxiety and the need for precision when performing dental procedures, it is not uncommon for dentists themselves to develop anxiety about causing pain to patients or making a mistake when performing a procedure.
The other aspects of dentistry are no less challenging. Many dentists work long hours, which makes balancing work, family, and other responsibilities difficult. Other stressors include difficult and uncooperative patients, dissatisfied patients, finances, business problems, collecting payments, paperwork/bureaucracy, time pressure, cancellations, no-shows—the list goes on and on. And that is not even taking into consideration major stressors, such as staff issues, board complaints, audits, and malpractice lawsuits.
When presented with these difficulties, dentists can become anxious and depressed. Some even seek out mood altering drugs and/or begin to abuse alcohol, in an effort to alleviate the stress.
Thankfully, there are resources available where dentists can turn to for help. Most dental associations have a subcommittee or group designed to provide confidential help to dentists struggling with emotional, mental and/or substance abuse issues.
For example, the Arizona Dental Association (AzDA) has a group called the Dentists Concerned for Dentist Committee (DCD). The DCD is a group of fellow dentists who work with other dentists to help them with substance abuse problems, with an emphasis on “cure and return to practice.” When the DCD is contacted, everything remains strictly confidential, and the State Board is not notified. As explained by the DCD, “[t]here should be no grief or shame in seeking help.” Accordingly, DCD records are “sealed and cannot be accessed by anyone.”
If you are a dentist in Arizona struggling with substance abuse, or you know a dentist who is, consider contacting the AzDA so that a referral can be made to the DCD. You can find the contact information for the AzDA here.
If you live outside Arizona, consider contacting your local dental association to see if it has a similar program.
Remember, it’s ok to ask for help.
“When Life Feels Just Too Hard,” INSCRIPTIONS, Vol. 30, No. 8 (August 2016) at p. 24.
In Part 1 of this post, we discussed the anatomy of the spine and some of the causes of Degenerative Disc Disease (DDD). In Part 2 of this post, we will be discussing some of the symptoms of DDD, and some of the methods used to treat DDD.
Not all people with intervertebral disc degeneration experience pain or other symptoms. This is due to the fact that the degeneration of the discs, by itself, does not bring on the symptoms described in the first paragraph above. However, as disc degeneration becomes more severe, it can lead to other conditions that bring on the symptoms people normally associate with DDD (e.g., pain, numbness and tingling, weakness, etc.). Some of the conditions commonly associated with DDD are:
- Spinal osteoarthritis: Sometimes referred to as spondylosis, this condition occurs when the breakdown of the cartilage and intervertebral discs leads to increased contact and irritation of the vertebrae. It may also lead to the formation of osteophytes (abnormal bone growths) on the vertebrae that can also put pressure on nerves and contribute to the pain and nerve-related issues described above.
- Spinal stenosis: This condition can occur when an individual develops spondylosis. The inflammation associated with spinal osteoarthritis may cause a narrowing of the spinal canal (the hollow space in the middle of the vertebrae through which the spinal cord travels) and put pressure on the spinal cord. This pressure on the spinal cord can cause numbness, weakness, cramping, or general pain in the arms and legs. In some cases it can also cause bowel and bladder dysfunction.
- Foraminal stenosis: This condition is the result of reduced space between the vertebrae, often brought on by the degeneration of the intervertebral discs. The reduced space may lead to increased pressure on nerve roots emerging from the spinal cord, resulting in localized pain as well as numbness, tingling, and weakness in the extremities.
Because DDD can cause such a broad range of symptoms and subsequent conditions, the treatment options vary widely. Depending on the circumstances, treatment can range from conservative options, such as physical therapy and anti-inflammatory medications, to surgical intervention, in the form of a discectomy, laminectomy, laminoplasty, or spinal fusion.
If you are experiencing any of these symptoms, the best course of action is to consult a physician.
For more information on how disability insurers evaluate claims based on Degenerative Disc Disease, see:
This post is the first in a series we will be doing on common orthopedic issues. In Part 1 of this post, we will discuss the anatomy of the spine and some of the causes of Degenerative Disc Disease (DDD), a common yet misunderstood spinal condition that affects a large portion of the population. In Part 2 of this post, we will go over some of the symptoms of DDD and some of the methods for treating DDD.
There are thirty-three vertebrae in the vertebral column of the human spine, twenty-four of which articulate and move. Between each of the vertebrae in the three articulating sections of the spine – the cervical, thoracic, and lumbar spine – there is an intervertebral disc. Each disc, composed of soft jelly-like center (nucleus pulposus) surrounded by a capsule of connective tissue (annulus fibrosis), provides shock absorption and flexibility within the spine. There is very little blood flow to this region of the body, and if discs are damaged or deteriorate they cannot regrow or heal themselves.
Degenerative Disc Disease (DDD) is the breakdown in the size and cushioning of the intervertebral discs, which can lead to chronic pain, weakness, numbness and tingling in extremities, and reduced flexibility in the spine. The name of the condition is actually somewhat of a misnomer – it is not actually a “disease”, but rather a condition that is characterized by the degeneration of the intervertebral discs over time. Because of this, the condition can be confusing to understand.
Reduction in the size and cushioning of your discs is part of the normal process of aging, and magnetic resonance imaging (MRI) studies have shown that almost everyone over the age of 60 has degeneration of their intervertebral discs to some degree. Not all people with disc degeneration have back pain or other symptoms – in fact, individuals with relatively mild disc degeneration may experience no symptoms whatsoever.
However, age is not the only factor in DDD. Deterioration of the intervertebral discs can be accelerated and exacerbated by other factors. The culprit in many severe cases of DDD is stress-related damage in the form of repetitive use, trauma, injury, poor posture, poor movement, and obesity. Among these, one of the most common factors is repetitive use.
Medical professionals are particularly susceptible to developing DDD due to the static postures that some specialties require in clinical practice, most notably dentists. For example, the repetitive, static posture of a dentist performing clinical procedures creates compressive forces on the cervical discs due to neck flexion and compressive forces on the lumbar discs due to axial loading (the weight of the body compressing the spine vertically). When these compressive forces are applied for year after year on a daily basis, the result can be an accelerated deterioration of the intervertebral discs.
For more information on how disability insurers evaluate claims based on Degenerative Disc Disease, see:
In past posts, we have discussed Unum’s track record of wrongfully denying disability claims and Unum’s bad faith efforts to avoid paying legitimate claims. Unum was again in the news last year when it made significant changes within the upper echelons of company management. Unum is now making headlines again, due to speculation that it is in the process of outsourcing hundreds of jobs overseas.
Unum is apparently currently in talks with several information technology (IT) firms to outsource up to 350 jobs to India. A Unum employee, who spoke to the Portland Press Herald on the condition of anonymity, told the newspaper that as many as 200 jobs could be cut at Unum’s Portland, Maine offices, and estimated that the cuts could affect up to 350 jobs company-wide. The employee reported that Unum was meeting with several vendors to discuss different levels of sourcing. Florida attorney Sara Blackwell, who operates the website ProtectUSWorkers.com, claims that Unum has met with Cognizant and HCL – two multinational IT consulting firms – to discuss the potential move. In an interview with the Times Free Press, Ms. Blackwell expressed concerns that policyholders’ personal medical information may be compromised by outsourcing to countries that don’t have strict provisions such as HIPAA to protect the medical records of policyholders.
It will be interesting to see if Unum’s outsourcing efforts end with its IT department, or whether this is the first step towards Unum outsourcing positions that play key roles in the disability claims process, such as claims managers and in-house medical consultants.
In a previous post, we discussed how a woman with the same age, job and health history as a man can end up paying an average of 25% (and in some cases, 60%) more for the same level of disability insurance protection. We also discussed how some insurance companies raise premiums based on conditions unique to one’s sex, such as pregnancy.
When we first addressed this issue, the Massachusetts legislature was considering a bill that prohibited insurers from charging higher rates to women than to men. At the time, Massachusetts law prohibited insurance companies from using race and religion as rating factors when determining the cost of insurance, but there was no law against using gender as a rating factor.
Recently, the Massachusetts Senate voted to approve a budget amendment adding gender to other rating factors that insurance companies are not allowed to consider when determining the cost of premiums. The bill passed by a wide margin: 32 senators in favor of the amendment, and only 6 senators voting against the amendment.
It will be interesting to see if, in the future, other states follow suit and start to pass laws requiring insurance companies to give men and women the same premium rates for the same level of disability coverage.