We are a Phoenix, Arizona-based healthcare/professional disability insurance law firm with a national reputation for obtaining successful results for our clients.
Our firm has represented physicians, dentists, lawyers, executives and other professionals throughout the country, with the goal of securing and protecting their entitlement to benefits on own-occupation disability insurance policies.
Unfortunately, all too often securing benefits is a struggle for unrepresented professionals. Physicians, dentists and other professionals are typically not trained in law or insurance, including the critical and complex components of claims management, and disability insurance companies take advantage of this.
Many professionals do not realize that, in addition to their disability claims analyst, their disability insurance company has a team of attorneys, physicians, vocational consultants, surveillance personnel, and others working behind the scenes to find ways to limit, deny or terminate their disability insurance benefits.
Many professionals also mistakenly believe that disability claim approval is the end of the process. In reality, it is only the beginning as companies shift their focus to claim duration, pushing for a quick recovery and return to work.
This is especially true for certain types of claims/medical conditions that are closely monitored and targeted for denial or termination. And, predictably, the best way for companies to deny claims is through what they call “early intervention,” the development of information early in the claim, before the policyholder is represented.
Currently, we are noticing that insurers are trending toward being more aggressive when investigating claims, due to a recent increase in claims filed and the financial uncertainty created by the COVID pandemic. To learn more about the latest tactics disability insurers are employing to deny or reduce benefits, please read our blog post on 2021 disability trends and our outlook for 2022.
Each disability insurer operates differently. Therefore, it can be difficult to know how your claim is progressing if you have never filed a claim with your insurer. If you don’t know anything about your company or its claims management training/strategies, actuarial expectations, underwriting standards and risk management approach, it can be difficult to gauge whether your claim is being targeted for denial until it is too late.
Our disability insurance attorneys are heavily embedded in this niche industry, representing clients, litigating cases, and constantly tracking trends and legal decisions. Unfortunately, we find that judges are all-to-often forced to dismiss policyholders’ lawsuits because they did not make legal claims under the right statute/legal theory, factor in policy requirements to their practice transition plan, or otherwise take timely and proper actions to preserve their legal rights.
As just one example, very few people realize that private disability insurance policies that are purchased and paid for by individuals are treated very differently, and governed by different laws, than policies that are sponsored by employers. Insurance defense attorneys in this specialized industry are very adept at taking advantage of this lack of knowledge to eliminate claims, limit recovery, and/or delay accountability for their insurance company clients.
At the same time, dealing with a disabling condition while transitioning out of medical or dental practice can be very draining—physically, emotionally and financially. It is a very stressful time, and often the last thing you want to do is meticulously analyze the provisions of your disability policy, or deal with an claim analyst ambushing you, your staff and/or your doctors with calls, demands for statements under oath, or impromptu recorded interviews. Because of this, it is important to be represented by experienced disability insurance attorneys from the outset of the claim.
Our law firm’s job is to make sure you are paid the disability benefits you are entitled to under your policy. While our law firm does represent professionals whose disability claims have already been wrongfully denied or are being targeted for denial/termination, ideally, we consult with physicians, dentists, attorneys and other professionals from the moment they realize that they may need to file a claim.
Our disability insurance attorneys assess whether you have a valid claim and identify issues that you may run into when filing. In situations involving slowly progressive conditions, we evaluate when it might be appropriate to file a disability claim and work with our clients to prepare a plan for their eventual transition out of practice, taking into account their particular circumstances and the requirements of their disability policies.
When it comes time to file, our disability insurance attorneys handle all aspects of the claim. We require that disability insurance companies coordinate all requests for information through our law firm, so that we can monitor the requests and ensure that they are warranted and appropriately carried out.
When disability insurance companies require interviews (of yourself, your employer, your staff and others), depositions/statements under oath with their attorneys, Independent Medical Exams (IMEs), Functional Capacity Exams (FCEs), or other examinations, our disability insurance law firm ensures that your company’s representatives do not engage in improper questioning or bad faith conduct.
We then continuously monitor each disability claim and utilize our extensive industry knowledge to preemptively identify, document and combat the insurance companies’ improper tactics, including improper and intrusive surveillance, before these tactics come to fruition in a claim denial or termination.
Our professional clients hire our law firm because of the results we consistently deliver. We partner with our clients and any co-counsel as a unified team, with the goal of securing our clients’ disability insurance benefits rather than “managing” their expectations.
Developing a methodical plan is critical to our approach, especially for our clients who have conditions that are easier to undercut, and claims that more likely to be denied or terminated.
Ranking Arizona has repeatedly recognized Comitz | Stanley as one of the state’s top boutique law firms, ranked #1 for our healthcare practice. Despite our firm’s small size, we outrank large regional, national and international law firms in healthcare, primarily due to our reputation for results in professional disability insurance claims and litigation.
Arizona Business Magazine lists Ed Comitz as one of the Top 5 Business Leaders in the field of Healthcare, and one of the Top 500 Business Leaders in Arizona overall. Referring to the honorees, Editor-In-Chief Michael Gossie commented: “The drivers of Arizona’s economy who are profiled … are leaders. They are innovators. They have influence. And when they speak, they make things happen.”
Accolades such as these, and the outcomes that drive them, are the result of our unprecedented industry experience, focus, talent and approach.
For almost 30 years, Ed has developed the only law practice in the country that focuses exclusively on professionals’ “own occupation” disability claims and litigation. As a result, Ed knows the disability insurers’ playbook, exactly how they operate, and how they approach high-dollar, “own occupation” claims (typically owned by physicians, dentists and attorneys).
Through years of hard-fought litigation, Ed has earned the respect of, and has developed relationships with, senior executives, disability claim department heads, in-house legal counsel and outside legal counsel at all of the major disability insurance carriers.
Claims involving our law firm are often “tagged” to warn the companies’ claims analysts to take care in conducting themselves.
Our professional disability law firm intensely focuses on only a select, small number of matters at a time, so that all members of our team have a command over the facts and legal issues at play.
Our attorneys personally vet each disability claim/case before accepting representation. We are selective in the matters that we take and all of the major disability insurers know that if we accept a matter, it is one that we personally believe in and will endlessly fight to protect.
After paying high premiums for years and even decades, professionals expect to be paid the disability benefits they are entitled to, and are often frustrated by the disability claims process. We are often asked, why is it so hard to collect benefits? Unfortunately, whether you are able to collect benefits without a fight often has more to do with the financial motivations of your disability company than the merits of your disability claim.
When disability companies first started marketing to doctors and other professionals, there was a high degree of market competition. Insurance companies viewed physicians, dentists, attorneys, executives and other professionals as high-income earners who could (and would) pay high premiums that the disability insurers would then invest in the high interest market.
Insurance company actuaries also determined that professionals would rarely file disability insurance claims. Their theory was that doctors, lawyers and executives would instead choose to work through limiting conditions because they make so much money (even working part-time), have already invested a lot of time and money into their careers, hold titles and positions that are a large part of their identity, and work in occupations where the needs of clients/patients are their top priority.
This competition initially resulted in policies that had highly favorable provisions for professionals, including lifetime benefits, cost of living adjustments, and true “own occupation” coverage that allowed you to collect benefits and work in a different occupation if you became disabled.
During the height of market competition, insurance companies attempted to sign as many professionals as possible by liberalizing policy terms, significantly relaxing their underwriting criteria for professionals with preexisting conditions, and grossly overselling what turned out to be very good coverage.
For a time, the disability insurance industry appeared profitable, but when interest rates plummeted and professionals started filing claims, it soon became apparent that the companies had substantially underestimated how many policyholders would file legitimate claims.
In addition to the drop in interest rates, the industry did not take into account that doctors’ incomes were being significantly reduced by changes in medical/dental reimbursements, HMO’s and capitation plans. And since the companies’ payouts on permanent disability claims frequently exceeded a million dollars per claim over time, the carriers started to hemorrhage hundreds of millions of dollars.
Just to keep afloat, some insurance companies abandoned their professional policies and sold this block of business to larger companies at a discount.
This in turn created conflicts of interest. You would purchase a policy from one company, but it was being administered by a different company that may not even sell insurance. That company only made money if premiums came in and benefits were not paid out. As a result, successor disability insurance companies and third-party administrators began to aggressively manage and deny claims, and targeted existing claims for termination.
Some of the larger companies that stayed in the market have tried to save money by engaging in bad faith practices, many of which our firm has uncovered through investigations and discovery in lawsuits across the country.
Some of these practices have also been uncovered through investigative reporting, including segments on Dateline and 60 Minutes featuring disabled physicians and dentists having problems with Unum, Paul Revere, Provident, MetLife, Hartford and others. These bad-faith practices include:
Eventually, whistleblowers brought these sorts of practices to the attention of insurance commissioners, and they in turn conducted market conduct exams of major companies such as Unum, Guardian, MetLife and others.
As a result of this scrutiny, many disability insurance companies that had initially stayed in the market determined that they needed to cut their losses. Companies like Unum and Metlife stopped selling individual disability insurance policies, and closed that block of business.
At the same time, other companies, like Disability Management Services (DMS), used this as an opportunity to market themselves as third-party administrators that would come in and aggressively “manage” unprofitable blocks of business and take over disability claims for insurers that wanted to distance themselves from the claims process while still keeping some of the financial benefit from the policies they had sold.
Still other companies, like Great-West (which owns the American Dental Association disability group plan), have taken a middle path, selling off some of their policies while entering into arrangements with other companies (like Protective) to administer disability claims under the policies that they want to keep.
Over the last several years, all companies have now taken a different approach with newer claimed “true” own-occupation policies. Policies are now less expensive and insurance companies have revamped their policy terms to give themselves more investigative tools and broader discretion, while adding additional exclusions and limitations, and crafting pitfalls designed to make it much harder for professionals to collect benefits.
Disability insurance policies that used to be only 5-10 pages long transformed into 50-60 page documents as the companies added language intended to make it much harder to collect, such as:
The end result is that medical and legal professionals filing a disability claim face a war on two fronts. They must be wary of the financially-motivated bad faith tactics that disability insurance companies use to wrongfully deny claims, while at the same time avoiding policy traps and technical violations of their policy that might give their insurer a basis to terminate or reduce their benefits.
Our law firms’ Phoenix, Arizona-based disability insurance attorneys represent physicians, dentists, lawyers and executives filing disability claims in Arizona. Our main office is in Phoenix/Scottsdale, but we also have a satellite office in Tucson, and work with clients in Flagstaff, Sedona, Yuma, and throughout the state of Arizona.
Our law firm also makes an effort to speak with physicians and dentists regularly about the disability claims process and the challenges they might face when filing a disability claim. Our attorneys regularly attend and give CE presentations at medical and dental conventions, including the annual Arizona Dental Association conferences in Glendale, Arizona (formerly in Phoenix, Arizona), the annual Arizona Society of Anesthesiologists conventions in Scottsdale, Arizona, and the Dentaltown convention held in Phoenix, Arizona. We write articles for several Arizona-based medical and dental magazines, and Ed Comitz is regularly interviewed as a guest on many Phoenix, Arizona-based podcasts, such as the Doctor Money Matters podcast and the Dentistry Uncensored Dentaltown podcast.
For more information about filing disability claims in Arizona, please visit the Arizona Disability Claims sub-section of our disability insurance blog.
While our disability insurance law firm’s offices are located in Arizona, our disability insurance attorneys also work with clients and attorneys across the country who are looking for someone with more expertise in this discrete area of law. Our attorneys are widely published in this area, including Physician’s Money Digest, Doctor of Dentistry, Ophthalmology Management, Anesthesiology News, Dentist Money Digest, and MD Magazine.
We serve as local counsel in Arizona for attorneys looking for experienced disability insurance attorneys to resolve or litigate disputes with disability insurance companies, and our attorneys are also licensed in California, Oregon, Utah, Missouri, Kansas and Florida, in addition to Arizona.
If you live in another state, we regularly work with local counsel to assist professionals throughout the country, and are happy to discuss whether this might be an option for you.
Many dentists, physicians, attorneys, business executives, and other professionals are generally aware of the concept of insurance bad faith, and assume that is something they always have to fall back on if their disability claim is denied.
What you may not realize is that the rules in each state are different—some states don’t recognize bad faith, and others have specific rules for how a bad faith claim must be made. Some states have codified bad faith in statutes, other states tie it to breach of contract claims, and other states’ bad faith law evolved out of the common law.
Additionally, there are various defenses to bad faith that can also vary from state to state. For example, whether or not the claim decision was a close call (or, in legal terminology, “fairly debatable”) is a significant factor and defense in many states.
Disability insurance companies are fully aware of these rules and defenses, and factor them into how they draft their policies and how they approach claims. As a result, the cards are, in that sense, stacked against you from the start.
If you allow your insurer to dictate how the claim proceeds, and how your file is documented, you may have an uphill battle establishing bad faith if/when your claim is denied. Disability insurance companies are quick to take advantage of claims where the insured is subjected to a recorded interview without legal counsel, where there is a purported “lack of supporting information,” claimed “gaps” in the medical records, or surveillance taken out of context.
Unfortunately, the disability insurance industry has also heavily lobbied legislatures, redrafted professional disability policies and claim forms (particularly for physician, dentists, and attorneys) and has otherwise engaged in strategies that have impacted laws in their favor over the last 20 years or so. In addition, disability insurance companies generally have greater expertise, financial resources and perseverance than a lone insured, unrepresented by legal counsel experienced in the industry.
Accordingly, it is important that your claim is presented in the most comprehensive and legally defensible manner from the very outset.
The below case excerpts provide some basic information regarding how each state’s highest court has discussed the legal concept of insurance bad faith, generally.
The excerpts below are not meant to be a comprehensive discussion of each state’s bad faith or insurance law, and the holdings below have not necessarily been directly addressed in a first-party bad faith setting involving disability insurance policies. They are merely meant to highlight some interesting aspects of how each state conceptualizes “bad faith,” and to act as a resource/starting point for those interested in learning more about how insurance bad faith works in their state.
Some disability insurance policies are also subject to federal laws that can preempt state law and state remedies. You should always speak with an attorney before making any legal arguments relating to your disability claim.
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