All About Disability Insurance with Dentaltown’s Howard Farran DDS, MBA

Edward Comitz is talking about disability insurance with Howard Farran, the founder and publisher of Dentaltown Magazine. Ed will be discussing why and when to buy disability insurance and what to avoid or look for when you do.

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Should Disability Insurance Companies Be Deciding What Kind of Care You Receive?

What role should your insurance company play in determining your treatment options?  In our article, “Can Your Disability Insurer Dictate the Terms of Your Care?” by Ed Comitz and Michael Vincent, we discussed how, depending on the terms of your insurance policy, insurers can dictate what care you should receive, and whether you can be forced to undergo surgery in order to continue to receive policy benefits.

When prescribing you a specific treatment or medication, your doctor usually has very specific goals in mind.  First, they want to medically treat you in the best way possible.  They want to provide you with the best means for curing or coping with your situation after considering the totality of your circumstances and your recovery goals.  Second, they want to make you feel better and help you recover from your ailments if possible.

For example, if surgery isn’t an option for your consistently high levels of pain, your doctor may prescribe strong medication to give you the relief you need.  They may effectively manage the pain you struggle, but the side effects may impede you from returning to work.

Unlike doctors, insurance companies have one goal in mind: to get you off of their claims list and not pay monthly claim benefits.  They want you treated in a way that returns you to work in the short run and may not be as concerned about the long term side effects or repercussions of alternative treatment options.

One way they accomplish this is by having their doctor contact your doctor to discuss treatment alternatives.  Such alternative methods include using less effective medications that would allow you to return to work.  A strategy they employ is to point your doctor to studies like those outlined in articles like “Disability experts question long-term opioid use,” or “Reed Group Releases New Opioid Treatment Guidance in Disability Guidelines.”

What many people don’t realize is that the Reed Group, the company who released the “updated expert guidelines,” is a subsidiary of Guardian Life Insurance Company, parent company of Berkshire Life.  This company has a substantial incentive to downplay the safety and effectiveness of drugs, like opioids, that are able to manage acute pain, but render patients unable to return to work because of medication side effects.   These companies want to point your doctors to these guidelines to influence their bottom line by getting you back to work quickly.

The problem with this tactic is that these blanket guidelines do not take into account your pain, your needs, or your situation.  Yes, the alternative options may get you back to work, but in the long run you may experience repercussions.  Letting claims consultants, who aren’t medical professionals, or the insurance company’s doctors determine your care and treatment is a conflict of interest for insurance companies and is not always in your best interests.

Free, Lifetime Access Pass to National Parks and Federal Recreational Lands for U.S. Citizens with Permanent Disability

Summertime is traditionally a popular time to visit our National Parks, and for persons with permanent disabilities, the vacation can be a little less expensive if they obtain an Access Pass.  The Access Pass admits the pass owner plus 3 adults free of admission to more than 2,000 sites maintained by the National Park Service, the Forest Service, Fish and Wildlife Service, Bureau of Land Management or Bureau of Reclamation, and the passes are good for a lifetime.

The Access Pass can be obtained by U.S. citizens or permanent residents who have been medically determined to have a permanent disability that severely limits one or major life activities.  Some acceptable forms of proof of permanent disability include a statement from a licensed physician, a document issued by a federal agency such as the VA, SSA or SSI, or a document issued by a state agency, such as a vocational rehabilitation agency.

Further information on obtaining and using an Access Pass is available on the U.S. Geological Survey’s website.

President Obama Proclaims Today “International Day of Persons with Disabilities 2012”

A PROCLAMATION

Americans have always understood that each of us is entitled to a set of fundamental freedoms and protections under the law, and that when everyone gets a fair shot at opportunity, all of us do better. For more than two decades, our country has upheld those basic promises for persons with disabilities through the Americans with Disabilities Act — a sweeping civil rights bill that moved our Nation forward in the journey to equality for all. And from making health care more affordable to ensuring new technologies are accessible, we have continued to build on that progress, guided by the belief that equal access and equal opportunity are common principles that unite us as one Nation.

On the 20th International Day of Persons with Disabilities, we reaffirm that the struggle to ensure the rights of every person does not end at our borders, but extends to every country and every community. It continues for the woman who is at greater risk of abuse because of a disability and for the child who is denied the chance to get an education because of the way he was born. It goes on for the 1 billion people with disabilities worldwide who all too often cannot attend school, find work, access medical care, or receive fair treatment. These injustices are an affront to our shared humanity — which is why the United States has joined 153 other countries around the world in signing the Convention on the Rights of Persons with Disabilities, which calls on all nations to establish protections and liberties like those afforded under the Americans with Disabilities Act. While Americans with disabilities already enjoy these rights at home, they frequently face barriers when they travel, conduct business, study, or reside overseas. Ratifying the Convention in the Senate would reaffirm America’s position as the global leader on disability rights and better position us to encourage progress toward inclusion, equal opportunity, full participation, independent living, and economic self-sufficiency for persons with disabilities worldwide.

We have come far in the long march to achieve equal opportunity for all. But even as we partner with countries across the globe in affirming universal human rights, we know our work will not be finished until the inherent dignity and worth of all persons with disabilities is guaranteed. Today, let us renew our commitment to meeting that challenge here in the United States, and let us redouble our efforts to build new paths to participation, empowerment, and progress around the world.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim December 3, 2012, as International Day of Persons with Disabilities. I call on all Americans to observe this day with appropriate ceremonies, activities, and programs.

IN WITNESS WHEREOF, I have hereunto set my hand this third day of December, in the year of our Lord two thousand twelve, and of the Independence of the United States of America the two hundred and thirty-seventh.

 BARACK OBAMA

Disability Insurers Revamping Consumer Image

Many healthcare providers, some of whom also offer disability insurance such as Aetna and Cigna, have introduced elaborate marketing campaigns this past year in an effort to change their image, according to Tanzina Vega of the NY Times.  These insurers want to be perceived as consumer-friendly healthcare companies, rather than merely insurance providers.  The timing of the major shift in marketing makes sense as speculation increases over the pending U.S. Supreme Court decision on the Affordable Care Act.  If the Supreme Court upholds the individual mandate, which would require millions of uninsured Americans to purchase insurance, then the market will expand considerably.  Therefore, a favorable ruling would enable insurers like Aetna and Cigna to target the uninsured Americans directly, instead of marketing health care packages to employers.

But even if the individual mandate in the Affordable Care Act is struck down, Vega says that many insurers will likely continue their direct-consumer marketing campaigns.  Why?  Many healthcare providers believe their future economic success largely depends on their ability to market directly to the consumer.  Therefore, they will continue designing, marketing and selling insurance packages tailored to individuals, the end consumer.

Although the NY Times article focuses primarily on marketing campaigns of healthcare providers, we may see a similar, albeit less dramatic shift in the way disability insurance companies market their products as well.  Disability insurance companies are already focusing on the end consumer because, like healthcare providers, they believe that future economic success depends on their ability to reach people directly.  Furthermore, it makes sense that disability insurers would implement similar marketing strategies as healthcare providers because often times the health insurance companies are also disability insurers, like Aetna and Cigna.

But actions often speak louder than words.  Although disability insurers may try to alter their marketing strategies to reposition themselves as consumer-friendly companies, there likely will not be a corresponding shift in the way they treat disabled professionals when handling disability claims.  Unfortunately, their own financial interests too often trump those of disabled persons.

Free Disability Insurance Information from Nonprofit

The Life and Health Insurance Foundation for Education (LIFE) published a disability insurance consumer guide for those with, or looking for disability insurance.  LIFE is a nonprofit organization whose mission is to educate people about the importance of health, life and disability insurance.  It does not endorse any particular product or company.

The LIFE consumer guide, What You Need to Know about Disability Insurance, gives an overview of different disability insurance plans and explains important disability insurance concepts you should know, such as the difference between social security and private employer-sponsored disability insurance plans.  Did you know that 3 in 10 workers will become disabled for three months or more during their career?  This statistic is unsettling, but it becomes even more unnerving when you compare it with the fact that less than 1/3 of workers in the private industry even have long-term disability insurance plans.  In the brochure, LIFE explains the implications of this data and provides other statistics regarding disabled persons.  The disability insurance consumer guide also offers a worksheet to help you assess the income you would need to sustain your current standard of living if you were to become injured or disabled.  This information can be helpful for those looking to modify or purchase a private disability insurance plan.

Choosing an appropriate plan that is tailored to your needs can save you money and help you avoid litigation.  Disability insurance attorneys at Comitz | Beethe can answer your questions about private disability insurance claims and disability insurance bad faith.  We make sure disability insurance companies honor their agreements when they evaluate your disability insurance claim.  For more resources about disability insurance plans and disability insurance bad faith, and for answers to common questions about disability insurance claims, be sure to check out the resources tab on our website.


Private Investigators “Pretexting” to Deny Disability Claims

Private investigators hired by disability insurance companies pretext to acquire your personal information from others.  They do this by pretending to be someone else (often you), contacting people you know, and then probing them for your sensitive information.  Pretexting is not only deceptive and unprincipled, but it may also be illegal.  Private investigators engage in this conduct to produce evidence that will enable insurance companies to deny your disability insurance claim.

The Gramm-Leach-Bliley Act specifically addresses pretexting as it pertains to obtaining personal information from financial institutions.  Many private investigators believe the scope of the Act is limited to pretexting with financial institutions only, therefore, they assume other pretexts—those not involving contacts with your financial institution—are legal.  This is a misconception, however, according to Joel Winston, the Associate Director of the FTC, Division of Financial Practices.  In an interview with PI Magazine, Winston clarifies the scope of the Act:

First, we should dispel the misimpression, if there is one, that the pretexting provisions of [the Gramm-Leach-Bliley Act] only apply if the pretexter is getting “financial information.”  Actually, what the statute says is if you are getting any personal, non-public information from a financial institution or the consumer, that is covered by the statute.

(emphasis added).  Winston also answers other questions about pretexting as they relate to private investigators.  Although the Q-A session is mainly designed to illuminate private investigators of legal fences surrounding the practice of pretexting, it is also an excellent source of information for those who fear they might become victims of unlawful pretexts, or for people who want to learn more about the illegality of pretexting.

To view the article click here.

Report Says Insurance Software Unfair to Disabled Insureds

Many large insurance companies use claims software that enables them to “low-ball” consumers and manipulate claims payments, according to a new report from Consumer Federation of America. This software may also enable insurance companies to more easily deny disability insurance claims.

The report examines Colossus, injury evaluation software widely used in the insurance industry.  According to the report, Computer Sciences Corporation (“CSC”) developed the software and originally marketed it to insurance companies as a cost-saving product.  The marketing campaign changed quickly, though, as companies became concerned that the word “savings” would expose them to litigation—injured consumers could argue the so-called “savings” were actually a result of unjustifiably low claims offers.  The “savings” concept was familiar to insurance companies, but according to the report, CSC never mentioned the “savings” word when it presented the software to the California Department of Insurance.

Even though CSC changed the marketing semantics, it did not modify Colossus in any important way.  The report shows how insurance companies manipulate the software to achieve significant savings.  These “savings” are actually the result of computer-generated “low-ball” claims offers and payments to consumers, according to the report.

To read Consumer Federation of America’s the full report click here.

 

Insurance Bad Faith: Private Investigators and Their Surveillance Practices

Insurance companies often will hire a private investigator to aid in terminating disability insurance claims.  Ostensibly, the purpose of a private investigator is to expose dishonest individuals of fraudulent disability insurance claims.  A private investigator may even advertise as a “Disability Insurance Fraud Specialist.”  All too often, however, insurance companies and their investigators are not seeking to expose fraud, but to manufacture it.  They produce “evidence” only to aid in denying disability insurance claims—even wholly legitimate ones.  They do so because there is a strong financial incentive to deny disability insurance claims.

At Comitz | Beethe, we have dealt with these insurance companies and their private investigators time and again.  We know how they operate and how to prepare our clients.  We have developed a short list of basic information about private investigators so you can know what to expect:

  • When are they watching?  In a previous post, we noted the five most popular times for disability surveillance: (1) holidays, (2) birthdays, (3) weekends, (4) activities claimant listed in insurance company’s activity log; and (5) near the end of fiscal quarters.
  • Who are they?  Typically, private investigators are just as the name indicates – private people from private companies.  Disability insurance companies contract with these private companies to conduct surveillance on disability claimants.
  • What are their surveillance methods?  Particular tactics will vary depending upon the private investigator, the disability insurance company and the disability claimant.  However, many methods are common across the board.  Basically, the private investigator will inconspicuously follow a disabled claimant with a video-capturing device as the disabled claimant undergoes day-to-day activities.  If the private investigator has difficulty locating the disabled claimant, the investigator may use different tactics, such as pretexting, stake-outs or tracking devices, to locate and track the claimant.  Our last blog post describes these other tactics in detail.

The private investigation industry has a reputation for its shady practices.  At Comitz | Beethe, we uncover and expose private investigators’ objectionable “tracking” methods to protect our clients.  We hold insurance companies and their private investigators accountable under the law.

 

Private Investigator Surveillance Methods and Terms

Private investigators use a variety of tactics to produce evidence that may be used to deny your disability insurance claim.  Below is a list of different private investigator surveillance methods and terms.  

Disability Surveillance – refers to the monitoring, recording and documenting of activities or behavior of another.  In the disability context, this surveillance is called sub rosa surveillance.  Sub rosa, a Latin phrase which translated means “under the rose,” denotes the secretive and clandestine nature of private investigator actions.

Disability Stake outs – according to Shannon Detective Service, Inc.—a private investigation company whose client list includes Arizona Counties Insurance Pool, CNA Commercial Insurance, Danielson Insurance, Farmers Insurance, Federated Mutual Insurance Company, Hartford Insurance, Insurance Company of the West, Liberty Mutual Insurance, Nationwide Insurance, Progressive Insurance, Seabright Insurance Company, Sedgwick Claims Service, Travelers Insurance and Westfield Insurance—this is a stationary surveillance method by which a private investigator documents and records a claimant’s activities.  The hallmark feature of a stake out is that the private investigator does not move or follow the disabled claimant.  In a typical stake out operation the private investigator may station in front of your home or office and record you as you come and go.  The goal of the stake out is to produce evidence that will enable the insurance company to deny your disability insurance claim.  An ABC News story shows how an insurance company successfully denied a doctor’s disability claim with evidence produced during a stake out.

Disability Pretexting – the Federal Trade Commission (FTC) defines pretexting as “the practice of getting your personal information under false pretenses.”  Private investigators are engaging in illegal conduct when they use pretexting to obtain your personal information from a financial institution.  See 15 U.S.C. § 6801, et seq.

Here’s an example of how this works: someone pretends to be you and calls your bank.  The person claims to have forgotten your checkbook, account number, social security number or other sensitive information.  He then tries to get this information from the bank.  Such conduct constitutes pretexting and violates federal law.  Id.

Although private investigators claim to use only “appropriate” pretexting methods, methods which are not illegal per se, these are the same techniques which are used to facilitate identity theft and consumer fraud.  Check out the FTC website for more information about pretexting and how you can protect yourself.

Disability Tracking Devices and GPS – this area of the law is still evolving.  In a recent Supreme Court case, United States v. Jones, the Court held that attaching a GPS device to a vehicle constitutes a “search” under the Fourth Amendment; therefore, law enforcement officials need a warrant before installing the device.  132 S. Ct. 945, 949 (2012).  Although the Court did not address the attachment of GPS devices in the private investigation context, its decision largely turned on the physical trespass involved in attaching a GPS device to another person’s vehicle.  Id.  The Court stated:

It is important to be clear about what occurred in this case: The Government physically occupied private property for the purpose of obtaining information. We have no doubt that such a physical intrusion would have been considered a “search” within the meaning of the Fourth Amendment when it was adopted.

Id.  Therefore, this ruling may be used to argue against private investigator installations of GPS devices since such installation would also constitute a physical trespass.  Private investigation companies, such as Shannon Detective Services, Inc. (SDS), are now looking how to bypass the physical trespass issue altogether through implementation of other technologies that do not require physical attachment.  Here are two examples of other technologies cited from the SDS website:

  • Disability stingrays (a device that can triangulate a cell phone signal to locate a user) will become popular in the future as a way to skirt around the new GPS laws for law enforcement.
  • Disability ping of cell phones (by accessing a user’s cell phone GPS chip) will also fill the gap created by GPS legislation since the FCC has mandated GPS chips to  be installed in all new cell phones by 2018.

Driving with Disabilities and Vehicle Modifications

Many people with disabilities find that driving enables them to keep their independence.  The ability to drive means more opportunities for employment and participation in the community.  Unfortunately, in order for drivers with disabilities to stay behind the wheel post-injury, vehicle modifications are often needed.  Even though there is more opportunity for vehicle modifications today, the process can still be cumbersome, expensive and time-consuming.

In order to assist disabled persons with their vehicle modifications, the National Highway Traffic Safety Administration (NHTSA) has published an online brochure: Adapting Motor Vehicles For People With Disabilities.  The publication guides disabled persons through the decision-making process and offers cost-saving tips along the way.

Disability insurance attorneys at Comitz | Beethe understand that getting the insurance company to fulfill its obligation and pay your disability insurance benefits is only one step toward your independence.  If you are facing a disability or simply want more information regarding vehicle modifications for disabled persons, this brochure can be a helpful source of information.


Your Most Valuable Financial Asset

What is your most valuable financial asset?  According to Chicago Tribune columnist, Gregory Karp, for most people “the answer isn’t in their golden eggs, but in the goose that laid them.”  That is, their most valuable financial asset is not their car, house or retirement account, but their ability to make money.

When you suffer from long-term or short-term disability, you will likely be unable to continue working and, therefore, will lose your most valuable financial asset – your ability to earn money.  For many Americans without disability insurance, this financial blow can be devastating.

For this reason, in his article entitled Disability Insurance Primer, Karp stresses the importance of long-term disability insurance and provides a basic overview of what disability insurance is, what it is not, and how to find an appropriate plan.  The article is a good source for those seeking disability insurance or looking to change their current disability benefits plan.

Ed Comitz, disability insurance attorney in the greater Phoenix area, also provides answers to frequently asked disability insurance questions.  For example, in his blog post, Disability Insurance Policies: Which type do you own?, Mr. Comitz describes fundamental differences between individual, group and employer-sponsored disability insurance policies.  In another post, How to Get a Copy of Your Disability Insurance Policy, Mr. Comitz explains the process of obtaining a copy of your policy from the insurance company.  Finally, in How Specific is Your “Own Occupation”?, Mr. Comitz provides understanding about key terms within your policy and how insurers may try to classify these terms in a way to deny your disability insurance claim.

Out of Contract Demands:
When You Can Tell Your Disability Insurer “No”

Every disability insurance policy is a contract. With this contract come certain rights and obligations on the part of the disability insurance company and on the part of the policyholder. The insurer promises to pay you disability benefits and you promise to fulfill certain conditions. One of the most important things to remember about this contractual relationship is that if it’s not in your policy, you don’t have to do it.

Often, disability insurers will ask a person filing for benefits to do certain things or provide certain information in order to qualify for benefits. What every policyholder needs to realize is that the disability insurer cannot force you to do something that is not outlined in your policy. There are many examples of disability insurance companies’ demands that may not be required under the terms of the policy, such as:

• That you see a certain type of doctor

• That you undergo surgery for your disabling condition

• That you get a particular treatment or therapy

• That you provide your Social Security or workers’ compensation claim file

• That you attend a certain type of examination

• That you complete detailed descriptions of your daily activities

• That you allow a private investigator into your home

The bottom line is that a policyholder filing for disability insurance benefits should know what their policy requires and what it doesn’t. The best way to be sure an insurer doesn’t get away with making extra-contractual demands is to have a disability insurance attorney review your policy and advocate with the company for your rights.

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”

Guidelines for Reporting and Writing About People with Disabilities

Birth defect or congenital disability Fitconvulsion, or seizure?  Quadriplegicparaplegic, or person with a spinal cord injury?  Midgetdwarflittle person, or person of short stature?

The Research and Training Center on Independent Living at the University of Kansas publishes and updates a pamphlet called Guidelines for Reporting and Writing About Disabilities that is a helpful reference manual for understanding and using preferred and accurate terminology when writing on the subject of disabilities.

While there is not complete agreement on which terms are preferred, the booklet has been adopted into the Associated Press Stylebook, reflects the input of over 100 national disability organizations, and has been endorsed by the AIDS Action Council, National Down Syndrome Congress, Bazelon Center for Mental Health Law, Brain Injury Association of America, Post-Polio Health International, the National Council for Independent Living and many others.

In addition to specific terminology, the manual provides some general guidelines, including:

  • Do not focus on disability unless it is crucial to a story.  Avoid tear-jerking human interest stories . . . Focus instead on issues that affect the quality of life for those same individuals . . .People with disabilities actively participate in their communities and can participate even more when portrayed just like anyone else in the community.
  • Put people first, not their disability.  Say woman with arthritis, a child who has a learning disability, or person with a disability.  This puts the focus on the individual, not the particular functioning limitation.  Labeling the person as the disability (for example, a quad) dehumanizes the individual and equates the condition with the person.
  • Do not portray successful people with disabilities as heroic overachievers or long suffering saints.  Even though the public may find these portrayals inspirational, these stereotypes raise false expectations that all people—with and without disabilities—should be such “super humans.”
  • Avoid sensationalizing and negative labeling.  Saying afflicted withcrippled with, victim of, or suffers from devalues individuals with disabilities by portraying them as helpless objects of pity and charity.  It is more neutral to say an individual with AIDS than a person who suffers from AIDS.   Similarly, do not use emotional descriptors such as unfortunate or pitiful.
  • Emphasize abilities, not limitations.  For example, uses leg braces or walks with crutches is more accurate thanconfined to a wheelchair or wheelchair bound.
  • Bypass condescending euphemisms.  Disability groups strongly object to the use of euphemisms to describe disabilities.  Terms such as handicapable, differently abled, special, and challenged reinforce the idea that people cannot deal honestly with their disabilities.
  • Maintain the integrity of each individual.  Do not use words or phrases regarded as offensive.
  • Do not imply disease when discussing disabilities that result from a prior disease episode.  People who had polio and experienced after effects have post-polio syndrome.  They are not currently experiencing the disease.  Do not imply disease with people whose disability has resulted from anatomical or physiological damage…Reference to disease associated with disability is acceptable only with chronic diseases, such as arthritis, Parkinson’s disease, or multiple sclerosis.