Comitz | Beethe an Exhibitor at Osteopath
Convention in Scottdale, Arizona

The Phoenix disability insurance law firm of Comitz | Beethe is a Business Partner of the Arizona Osteopathic Medical Association and will be an exhibitor next week at the 90th Annual AOMA Convention at the Hilton in Scottsdale, Arizona.  We invite all osteopath physicians attending the convention to stop by our table — Exhibitor Booth #79 near the breakfast buffet tables — to say hello and pick up informational packets about our firm and Arizona disability insurance practice.

Questions to Ask When Choosing
a Disability Insurance Attorney

For those looking for help with their disability insurance claims, choosing an attorney is an important step. However, it can often be difficult to determine whether a particular disability insurance lawyer is the right one for you to work with. Here are some general questions to ask to help you evaluate a potential lawyer or law firm.

1. How many cases does the attorney take on each year?

2. What percentage of the attorney’s practice is devoted to disability insurance claims?

3. Does the attorney exclusively work with individual policy claimants, or does he/she handle ERISA and Social Security cases?

4. Has the attorney published any articles or been interviewed about disability insurance topics?

5. What insurance companies has the attorney dealt with?

6. Does the attorney offer comprehensive representation or short term assistance?

7. Does the attorney’s fee structure work for you?

8. What does the attorney expect to accomplish with your claim?

Selecting the right disability insurance attorney to help with your claim is a decision not to take lightly. You should never be afraid to ask questions, and the attorney will be glad to answer them.

CDC Adds State Level Disability Site

The Centers for Disease Control and Prevention (CDC) recently created a public online database containing state-by-state, disability-specific information.  Named the “Disability and Health Data System,” the CDC says that the database can help individuals “better identify health and wellness opportunities for people with disabilities by allowing users to compare over 70 different health measures, as well as data on psychological distress and disability-associated health care expenditures.”  For instance, users can access an interactive map with tables showing how often arthritis causes a work limitation for adults in each state.

If you are facing a disability or simply want more information about disabling conditions, the database can be a helpful source of information.

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.

Even Unum CEO Admits Their Insurance Policy Language Is Confusing

As we have blogged many times, even seemingly straightforward terms like “total disability” or “appropriate medical treatment” in your disability insurance policy may have different meanings in the context of a disability insurance claim than they do in everyday English.  In a video posted on YouTube, Jack McGarry, CEO, Unum UK, is surprisingly candid in addressing how their insurance policy language is confusing.

Insurance is so confusing, in large part because we’ve made it that way, the insurance companies.  We use acronyms instead of words, we use lingo instead of language.  We’ve made it easy for us to communicate with each other, but we’ve made it very, very difficult for consumers to understand what we’re saying, and we need to change that.

[Consumers] are confused by our products, they don’t understand the choices, they don’t understand the coverage, and one of the reasons they don’t understand it is because the language we use to describe it, they find it confusing, and a little scary, so we’re partnering with Plain English to help simply the language we use to describe what we do so everybody can understand it.

 

While Unum is apparently taking steps to clarify the language in its policies in the United Kingdom, it is of little help to American insureds who purchased policies written in language that is, in the words of Unum’s UK CEO, ”very, very difficult for consumers to understand.”  The help of an experienced disability insurance attorney to interpret the language of your policy can be critical in ensuring you receive the benefits to which you are entitled.

Will New Demands on Healthcare Professionals Lead to More Disabled Doctors?

A recent article by health insurance writer Allison Bell explains, from an insurance industry perspective, why the new administrative demands on health care professionals might lead to an increase in doctors facing disability:

[I]t seems reasonable to ask whether, for example, the new pressure to convert to electronic health records will lead to some physicians at small or understaffed practices to develop carpal tunnel syndrome and blurry vision from trying to enter, or at least, check, many of the records themselves. Will sleep deprivation related to an increase in workload cause or aggravate objective conditions, such as lack of exercise, obesity and high blood pressure, that will, in turn, lead to an increase in the number of doctors with disability insurance who suffer heart attacks. strokes and disabling car accidents?

Healthcare professionals: Do you think the push for electronic health records and the Patient Protection and Affordable Care Act will lead to an increase in disabled doctors?

Timing Is Everything: When to Discuss Your Potential Claim with a Physician

When it comes to disability insurance, your treating physician’s support can be critical to getting your legitimate claim approved. If your doctor can’t provide adequate documentation of your condition or is reluctant to get involved, there is a much higher chance that your claim will be denied. However, fully discussing your condition with a professional, compassionate treating physician will help ensure supportive medical records. When you are involved in a disability insurance claim, it is important to understand how to approach your treating doctor so that he or she can help you.

When to discuss your potential claim with a physician is an important timing issue. Instead of trying to enlist your doctor’s help at the very first visit, you should wait to talk to your treating physician until after he or she knows you and your condition well enough to opine accurately as to your ability to work. It is vital that you develop a relationship of trust and confidence with your doctor before inviting him or her to assist you in your claim. hysicians are often reluctant to support claims for benefits if they question the motivations behind the claims. A physician who has treated, without success, the policyholder making a legitimate disability claim will be more willing to cooperate with the extensive process.

Making It Through the Holiday Season with a Chronic Disability

The holiday whirl of activity, as well as potential strain on the pocketbook and relationships, can be exhausting to even the healthiest amongst us.  For a person with a debilitating, chronic disability, it is important to communicate to those with whom you’ll be sharing the holidays what you realistically will be able to keep up with and participate in.

Social media blogger Toni Berhard has written an excellent article, available in full here, about some of the ways in which you can try to keep expectations realistic.  Ms. Berhard provides her insights into the myriad ways in which the holidays can be a stressful time for persons with disabilities.

…The holidays can be a recipe for double disaster—the increase in activity exacerbates your physical symptoms, while coping with sadness, frustration, and maybe even guilt about your physical limitations give rise to emotional pain.  No wonder many people with health problems dread the approaching holidays.

Ms. Berhard suggests the following:

  • Share information with friends and family members about your condition.  This can be particularly important if you have a disability that does not make you “look sick.”   Forward a few links or print out select pages and keep your accompanying note on the light side. She suggests, for example, that you could write that “there won’t be a test” in the note accompanying informational materials about your condition.
  • Write a letter.  Avoid being accusatory or whiny and simply express how difficult it has been for you to adjust to the changes your disability has caused in your life and how you wish you could be as active as you used to be.  Briefly describe your day-to-day life, unpredictability of your condition, and how much can realistically be expected from you during the holidays.
  • Enlist a close friend or family member as an ally.  This person can be supportive if you need to excuse yourself in the middle of a holiday gathering, and can also nudge you when they see that you are overdoing it.
  • Ultimately, you may have to accept that not all friends and family members will recognize your limitations.

As this year and holiday season draws near its end, we hope you have enjoyed a wonderful holiday, and we wish you all a very Happy New Year!

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”

Dealing with a New Disability

A recent article by Pamela Poole in the Huffington Post offers a sensitive look at the challenges faced when a person becomes disabled.  The adjustments to be made, both by the person with the disability and by his or her friends and family, extend beyond the physical.   Ms. Poole summarizes the first ten months of her own sudden disability thusly:

denial denial indignation fear anger anger denial

anger depression depression medication

Poole chronicles not only her own struggle to accept the changes her disability made in her life, but the obstacles she faced in making her friends and family understand the new limitations on her abilities and endurance.  Ms. Poole’s article and references to books and articles she found helpful are available at this link.

The physical and emotional impacts of a disability are difficult enough.  If your disability insurance company is giving you the runaround, it can be helpful to have an experienced disability insurance attorney advocating on your behalf and guiding you through the claim process.


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.

FCC Proposal to Improve Advanced Communications to Disabled Consumers

On October 8, 2010, President Obama signed the Twenty-First Century Communications and Video Accessibility Act of 2010 (“CVAA”), described by the Federal Communications Commission as the “most significant piece of accessibility legislation since the passage of the Americans with Disabilities Act of 1990.”  The intent of the CVAA is to bring existing communications laws up to date to ensure that persons with disabilities are able to share fully in the benefits of broadband communications and other 21st century communications technologies.

This month, the FCC issued three Notices of Proposed Rulemaking to help implement the CVAA and ensure that persons with disabilities can fully enjoy the conveniences of such modern technologies as wireless handsets, Internet access, e-mailing, text messaging, video conversations.

If you are interested in reading the full text of the Twenty-First Century Communications and Video Accessibility Act of 2010, the CVAA and its history are available at this link: http://www.govtrack.us/congress/bill.xpd?bill=s111-3304

The Rising Number of Disability Claims

This chart, created by the Council for Disability Awareness (www.disabilitycanhappen.org), graphs the rising number of long-term disability claims in the United States over the past several years.