We’ve talked before about how diabetes can occur in conjunction with other diseases, such as anxiety, or contribute to certain medical conditions, such as radiculopathy. In this post we will be taking a broader look at diabetes and its complications.
Diabetes (diabetes mellitus) refers to a group of diseases, including prediabetes, type 1, type 2, and gestational diabetes. While prediabetes and gestational diabetes can be reversible, types 1 and 2 are chronic and there is currently no cure.
Diabetes can occur either when the pancreas produces very little or no insulin, or when the body does not respond to the insulin that the pancreas does produce. In this post we will examine only types 1 and 2.
Type 1 diabetes typically appears during childhood or adolescence (it is also called juvenile diabetes), and the symptoms come on quickly and are more severe. Type 2 diabetes is more common, and more often occurs in people over 40 (it is often referred to as adult onset diabetes). Those with type 2 diabetes may not exhibit symptoms at first.
- Increased thirst
- Extreme hunger
- Frequent urination
- Unexplained weight loss
- Ketones in the urine
- Blurred vision
- Difficulty breathing
Additional symptoms experienced in Type 2 diabetes include:
- Cuts or sores that are slow to heal
- Itchy skin (often in the groin area)
- Recent weight gain
- Numbness or tingling of the hands and feet
- Impotence or ED
Type 1 diabetes occurs when the body’s immune system destroys the insulin producing cells of the pancreas. Scientists believe that Type 1 is caused by genetic and environmental factors, such as exposure to certain viruses.
Type 2 diabetes is caused primarily by lifestyle factors and genes. Some risk factors include:
- Being overweight
- Lack of physical activity
- High blood pressure
- Abnormal cholesterol and/or triglyceride levels
- Family history (having a parent or sibling with diabetes increases risk)
- History of gestational diabetes while pregnant
- Polycystic ovary syndrome
Diabetes can be diagnosed based on blood tests that show a patient’s blood sugar levels, using a glycated hemoglobin (A1C) test, random blood sugar test, fasting blood sugar test, and/or an oral glucose tolerance test.
With respect to type 1 diabetes, a patient’s urine will be analyzed for ketones, a byproduct produced when muscles and fat are used for energy when the body doesn’t have enough insulin to use available glucose.
While there is no cure for diabetes, ongoing monitoring and management of symptoms is required to prevent serious complications from occurring. Possible treatments include:
- Diet/healthy eating
- Weight loss
- Those with Type 1 diabetes must take insulin because it is no longer made by the body
- Those with Type 2 may need to take insulin, but may also take different medications (such as metformin, which lowers the amount of glucose the liver makes)
- Bariatric surgery
- Artificial pancreas
- Pancreatic islet transplantation
Undiagnosted, untreated, or resistant to treatment, diabetes can have serious health consequences, including:
- Cardiovascular disease;
- Nerve damage (neuropathy), especially in the limbs (which left untreated can result in loss of feeling); nerve damage is also connected to problems with internal organs, weakness, weight-loss, and depression;
- Kidney damage (nephropathy), which may result in the eventual need for dialysis or kidney transplant;
- Eye damage (retinopathy), which may result in cataracts, glaucoma, or blindness;
- Skin conditions, including bacterial and fungal infections;
- Foot damage, which can often lead to the need for amputation;
- Depression; and
- Alzheimer’s disease (type 2 diabetes)—currently there is no agreed upon theory about why there is a correlation between the two diseases.
These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.
Center for Disease Control (CDC), www.cdc.gov
Mayo Clinic, mayoclinic.com
National Institute of Diabetes and Digestive and Kidney Disease, www.niddk.nih.gov
American Diabetes Association, www.diabetes.org
In our last post we discussed why you should not rely solely on your agent’s representations when purchasing a new disability policy. It is similarly important that you not rely solely on your agent to complete the policy application.
While an agent may offer to help you by filling out the application, this could end up negatively impacting a future claim or even voiding your policy down the road, if the application contains any errors or omissions. As explained in our prior posts, while it may seem like telephone interviewers, licensed representatives, agents, and medical examiners have significant control over the application process and whether you receive a policy, many applications have language that explicitly limits your ability to rely upon representations made by such individuals, and expressly places the burden of reviewing the application for accuracy upon you (regardless of who completed the application). Below is a sample of policy language:
Thus, you may speak with several people during the application process, and give them the requested information, but it is ultimately up to you to make sure the information provided to the insurance company is correct. It is therefore very important that you read through your application carefully to make sure it is complete and accurate before signing.
It is also very important that you carefully review your policy when you receive it from the insurance company, and not just file it away without a second thought. When you receive your copy of the full policy, it will typically contain language stating that you have a certain time period (e.g. 10 or 30 days) to review the policy and return it to be voided if it does not contain the terms you expected. This clause will normally be found on the first page of the policy, and typically looks something like this:
If you decide to keep your policy and do not send it back within this review period, you are bound by all provisions of the policy, regardless of whether you are actually aware of them or not. For instance, if you asked your agent for a certain provision and/or requested it on your application, but the insurance company omits it for some reason, and you don’t catch it during this review period, you may end up paying years of premiums for coverage that is different than what you thought you had purchased. Similarly, if your policy contains an unfavorable provision that you didn’t know was going to be in the policy, you will still be bound by it unless you return the policy.
Reading through contracts, especially lengthy insurance ones, can be time consuming. Many policies contain confusing language, terms of art, and often include supplemental riders that change the terms or definitions contained in the main body of the policy. But if you don’t read your policy until it’s time for you to file a claim, you may be caught off-guard by what your policy actually says. This next series of posts will discuss the importance of taking the time to read through your policy, and will review some things to watch out for when you buy a disability insurance policy.
Dentists and physicians are often swamped with work, and rely heavily on insurance agents when selecting and purchasing a policy. One scenario we commonly see is doctors requesting a policy that is “the same” policy that the other doctors in the practice have. Another common scenario is the doctor who wants more coverage and just asks his or her agent for another policy that is “like” his or her existing policy, or has the “same coverage” as his or her existing policy. What they don’t realize is that some of the same favorable terms may no longer be available in today’s policies. For example, while most older policies contained “true own occupation” provisions, there are now several different variations of “own occupation” provisions, so if you just ask for an “own occupation” policy, you may not actually be receiving the coverage that you think you are.
It is also important to be aware that, over the years, insurers have sought to distance themselves from agents and now often go so far as to include clauses or statements in their policies and applications that state no agent or broker has the authority to determine insurability or make, change, or discharge any contract requirement. Here’s an example of this type of policy language:
So what does this mean? It means that, while solely relying upon an agent’s assurance of the terms of a policy may have been a more acceptable (but not advisable) option in the past (when policies were often similar and generally favorable to policyholders), you can no longer solely rely upon your agent’s description of the policy. No matter how well-meaning or knowledgeable your agent may seem, ultimately, you are going to be on the hook if your policy doesn’t say what you thought it said, so it is crucial that you carefully review your disability policy to ensure you are receiving sufficient coverage.
Our next post will discuss the importance of the application process and policy review period.
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.
If you are thinking about filing a disability claim, you are likely wondering whether you will be able to meet your monthly expenses if you’re no longer able to work. You may have made a list of your necessary expenses, and likely included your disability insurance premium payments on that list, as your agent likely told you that your policy would lapse and you would lose your coverage if you missed a premium payment. At this point, you probably started to wonder whether you still have to keep paying the premium after you file the claim, and if so, for how long?
The answer depends on the specific terms of your policy. The paragraph that you’ll want to look for when you’re reviewing your policy is typically titled “waiver of premium,” but some policies address waiver of premiums as part of a larger section of the policy that discusses premiums more generally.
How Do Waiver of Premium Provisions Work?
Generally speaking, waiver of premium provisions state that your insurance company cannot charge premiums during periods of time when you are disabled. A waiver of premium provision typically will also require your insurance company to reimburse you for premiums you have previously paid during your period of disability (i.e. the premiums that you paid while the insurance company was investigating your claim).
Waiver of premium provisions are included in most disability insurance policies. If you are considering purchasing a policy that does not include a waiver of premium provision, you may have the option to purchase a waiver of premium rider.
Here is an example of a waiver of premium provision from an actual disability insurance policy.
Waiver of Premium Benefit
We will waive Premiums of this Policy from the date of Total Disability after the later of:
- 90 consecutive days of Total Disability, or
- The end of the Elimination Period.
When we approve the Waiver of Premium, We will refund any Premiums paid from the first day of Total Disability. Waiver of Premium will continue while You are receiving a Total or Partial Disability Benefit of this Policy or a Rider. When You are no longer eligible for Waiver of Premiums, You must resume payment of Premiums to keep Your Policy in force.
Under this policy, the waiver of premium provision requires you to pay premiums either for 90 consecutive days after you become disabled, or until the end of the elimination period (the elimination period is the number of days you must be disabled before you are entitled to benefits, and is usually noted on the first few pages of a policy).
So, for example, under this policy, once you have been disabled for 90 consecutive days, you no longer would have to pay premiums (at least until you recover from your disability, or your insurer terminates your benefits). You also would receive a refund of any premiums that you paid for any period prior to your date of disability.
Notably, the waiver of premium provision above also requires you to be receiving benefits for the waiver to apply. This is significant because, depending on the terms of your policy, in some cases you could be disabled but not receiving benefits. For instance, your policy might have a foreign residency limitation that prevents you from receiving benefits if you are living in another country, even if you remain disabled. In such a case, you might have to resume paying premiums until you returned to the United States in order to keep your coverage in force.
Timely and proper payment of premiums is critical, as a failure to pay premiums can result in you losing your disability coverage completely. It is important to read your policy carefully so that you have a clear understanding of when you are required to pay premiums, and when you are entitled to a refund of past premiums.
Most insurance companies will provide you with written confirmation that premiums have been waived, and it is best to keep paying your premiums until you receive this written confirmation, even if you think that you no longer have an obligation to pay premiums under the terms of your policy. If you have questions about whether your insurance company should have waived and/or refunded premiums under the terms of your policy, an experienced disability insurance attorney can review your policy and explain your rights and obligations under your particular policy.
Ed Comitz, one of the firm’s founding members, was recently named as a Top Lawyer in the field of insurance law in Phoenix Magazine’s special, 50th Anniversary Issue.
Mr. Comitz’s practice primarily focuses on helping physicians and dentists secure private disability insurance benefits. Mr. Comitz and the legal team at Comitz | Beethe also represent doctors in several other areas, including practice transitions, employment law, business litigation, estate planning, regulatory compliance, and licensing issues.
In previous posts, we have been looking at the findings from the most recent study on long term disability claims conducted by the Council for Disability Awareness. In this post we will be looking at the types of diagnoses associated with long term disability claims, and which types of claims are most common.
As you can see from the chart above, the most common type of both new and existing long term disability is musculoskeletal disorders—a category which includes neck and back pain caused by degenerative disc disease and similar spine and joint disorders.
This is particularly noteworthy because physicians and dentists, who often have to maintain uncomfortable static postures for several hours each day, are very susceptible to musculoskeletal disorders. In addition, claims involving musculoskeletal disorders can be challenging, because oftentimes there is little objective evidence to verify the pain. If you suffer from degenerative disc disease or a similar disorder, an experienced disability attorney can explain how to properly document your claim to the insurance company.
In previous posts, we have reviewed data collected by the Council for Disability Awareness related to long term disability claims. In the next few posts, we are going to look at the most recent study conducted by the Council for Disability Awareness.
To begin, here are a few of the notable trends that the study revealed regarding the gender, age and occupation of long term disability claimants:
- The majority of long term disability claims are filed by women.
- The average age of long term disability claimants has increased in recent years, with the vast majority of claimants filing between the ages of 50 and 59.
- The number of in-force individual disability policies for business management and administration, physicians and dental professional occupation categories increased, while the number of in-force policies for sales and marketing professionals decreased.
 The Council for Disability Awareness is “a nonprofit organization dedicated to educating the American public about the risk and consequences of experiencing an income-interrupting illness or injury.”
We’ve discussed the issues involved with “presenteeism” and how it can affect disability insurance claims, but it’s making waves in other news regarding healthcare workers and their patients. Healthcare workers are going to work sick, and while it is admirable to be dedicated to your job, it creates a huge risk to those with already compromised immune systems. Since healthcare workers are entrusted with the duty of caring for high risk patients, it’s important that we take care of our healthcare workers as well. However, that seems to not be the case, as in the medical field it is seen as weak to take days off, and sometimes taking more than two sick days is rewarded with an extra week of work for residents.
Here are some statistics that highlight this phenomenon:
95.3% of 504 physicians believed that working while sick put patients at risk. ((http://archpedi.jamanetwork.com/article.aspx?articleid=2344551))
83.1% of the 504, however, worked sick at least 1 time in the past year.
98.7% didn’t want to let colleagues down, and 64% feared being shunned by colleagues.
80% of a random sampling of 1,033 Norwegian physicians reported working even though they had symptoms that in a patient would be considered “sickness”. ((http://www.ncbi.nlm.nih.gov/pubmed/11355720/))
However, it’s imperative that we don’t blame healthcare workers, but instead society and its approach to doctors’ and dentists’ sickness as a whole. It doesn’t seem to make sense that we place such a heavy emphasis on coming to work no matter what when lives are at stake. While it would seem to be common knowledge that placing an already compromised immune system in jeopardy would be a bad idea, the medical community’s desire to work through diseases is contradictory to this, and perhaps it’s time to change the culture.
Physicians, what do you think about “presenteeism”, and how do you think we can change the culture surrounding it? Tell us in the comments.
A large part of our practice consists of helping physicians and dentists whose disability insurance claims have been denied or terminated. When our clients come to us, we carefully analyze their medical records, the claim file, and the law to craft a specific strategy for getting the insurer to reverse its adverse determination. Unfortunately, we sometimes find that in between receiving notice that their claim has been denied or terminated and getting in touch with our firm, doctors will inadvertently take actions that prejudice their claims. With that in mind, it’s important to review what to do and what not to do in the first few days after your claim is denied or terminated.
- In all likelihood, you will first find out that your insurer is denying or ending your disability benefits via a telephone call from the claims consultant who analyzed your claim. As we’ve explained before, the consultant will be taking detailed notes about anything you say during that call. Therefore, even if you are justifiably upset or angry, be very mindful of what you say. Anything you tell the consultant will certainly be written down and saved in your file.
- During the call with your consultant, make your own notes. You don’t have to ask a lot of questions at this stage, but you do want to make sure to record whatever information the consultant gives you.
- Following the phone call, you should receive a letter from the insurance company stating that it has denied your claim or discontinued your benefit payments. According to most state and federal law, the letter should have a detailed explanation of the evidence the company reviewed and why the insurer thinks that evidence shows you aren’t entitled to benefits. When you receive the letter, read through it carefully. Make notes on a separate document about any inaccuracies you identify.
- Make sure you keep a copy of the denial or termination letter as well as the envelope it came in. You should also make a note of the date on which you received the letter. The date the letter was actually mailed and received could be important to your legal rights in the future. Then, the best thing to do is to scan the documents electronically or make a photocopy for your file, just in case the original denial letter gets lost or damaged.
- Once you find out that your claim has been denied or terminated, you should contact a disability insurance attorney. Some doctors and dentists attempt to handle an appeal of their claim on their own, but we strongly suggest at least consulting with a law firm. Every insurance company has its own team of highly-trained claims analysts, in-house doctors, and specialized insurance lawyers to help it support the denial of your claim. Having your own counsel can level the playing field by making sure you know your rights under your policy and what leverage the applicable law provides you, and help you avoid the common traps that insurance companies lay for claimants on appeal.
- The lawyer you consult can be in your area, or it can be a firm with a national practice that’s physically located in another state. You may want to review these questions to ask potential attorneys before you decide who you would like to represent you.
- Whatever attorney you choose to contact, make sure you do so as soon as possible. In many circumstances, you will only have a limited amount of time to appeal the insurance company’s decision. Particularly in claims governed by the federal law ERISA, the clock starts ticking as soon as you find out your claim has been denied or terminated.
- It’s usually best to contact an attorney before you respond to the denial letter, to avoid saying anything that could prejudice your appeal. For instance, if you have a policy that is governed by ERISA, and you submit some additional information, the insurance company may not allow you to submit any additional information after your initial response.
- Before you meet with potential disability insurance lawyers, gather whatever documents you can to help them evaluate what’s going on with your claim. Our firm will always want to review the insurance policy or policies. (Here’s information on how to get a copy of your policy). We typically also like to see your relevant medical records and any correspondence between you and your insurance company. If you aren’t able to locate this information, it could cause delays in starting the appeal process.
- If you are a physician or dentist that is totally disabled, you should not try to go back to work just because your insurance company thinks you don’t qualify for benefits. Trying to practice when you aren’t in a physical or mental condition to do so could cause you to re-injure yourself or accidentally harm your patients. Of course, trying to work on patients after you’ve claimed that you are totally disabled can expose you to professional liability as well. Further, trying to return to work could impair your ability to collect your benefits upon appeal.
Comitz | Beethe’s has been named Arizona’s #1 Healthcare Law Firm by Ranking Arizona: The Best of Arizona Business.
Ranking Arizona publishes the results of an annual poll of the Arizona business community. Residents are asked to share their opinions of the best products, services and people in the state, including who they would recommend doing business with. Comitz | Beethe was selected as the state’s top healthcare law firm for its work representing physicians and dentists, including its handling of disability insurance claims for healthcare professionals.
The firm was also named as one of the top 5 Arizona law firms with 20 or fewer attorneys, the top 5 commercial litigation firms, and the top 10 real estate law firms.
Because of the high-stress nature of their occupations and their ready access to pharmaceuticals, both physicians and dentists are at high risk of developing substance abuse issues. In a recent disability insurance case, Colby v. Union Security Insurance Company & Management Company for Merrimack Anesthesia Associates Long Term Disability Plan, the United States Court of Appeals for the First Circuit recognized the challenges that doctors can face when they are disabled due to substance dependence.
The insured in this case, Dr. Colby, was a partner in an anesthesiology practice. Like many anesthesiologists, she kept a demanding schedule, working 60 to 90 hours per week. In 2004, her colleagues discovered that she had been struggling with chemical dependence after she was found sleeping or unconscious on a table in the hospital. She tested positive for Fentanyl, an opioid used in her practice.
This led to the revelation that Dr. Colby had been self-administering opioids, and had become addicted. Shortly thereafter, Dr. Colby entered inpatient substance abuse treatment. As of January of this year, Dr. Colby had not resumed using Fentanyl.
When her drug dependence first came to light, Dr. Colby filed a claim with her disability insurer. Even after completing her treatment, Dr. Colby feared that returning to the anesthesiology environment, where Fentanyl (along with many other drugs) was easily accessible, would lead to her relapsing. However, the insurance company denied her claim for benefits. The insurer argued that she had been discharged from substance abuse treatment, and that although she was still under a doctor’s care and feared a relapse, “a risk for relapse is not the same as a current disability.”
Ultimately, the Court of Appeals disagreed. Judge Selya explained:
In our view, a risk of relapse into substance dependence—like a risk of relapse into cardiac distress or a risk of relapse into orthopedic complications—can swell to so significant a level as to constitute a current disability.
As this case demonstrates, doctors struggling with substance dependence should be cognizant of the fact that their occupation puts them at higher danger for relapse, and may contribute to their total disability from practicing. If you are facing this situation, it’s important to talk to your treating providers, attorney, and disability insurer about how your work environment affects your risk of relapse.
Review the entire Colby opinion here.
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.