Filing for Disability Insurance Benefits
In the Wake of Coronavirus:
What Every Dentist Should Know

Now that the COVID-19/Coronavirus epidemic has reached the U.S. and spread throughout the country with no end in sight, dentists are being forced to face the reality that they may have to go without income for weeks, or maybe even months.

Some states, like California and New York are ordering dentists (and everyone else) to close their offices and shelter-in-place. And the American Dental Association (ADA) has called upon dentists to postpone elective procedures for the next three weeks.

In Utah, many dental offices have closed or drastically cut back on seeing patients following the ADA’s statement and the Utah Dental Association’s warning that dentists are “one of the highest risk categories for transmission and contraction of the virus, with many routine dental procedures potentially transmitting the virus.”

Similarly, in Arizona, Governor Doug Ducey has discontinued “all non-essential or elective surgeries, including elective dental surgeries, that utilize personal protective equipment or ventilators” in an effort to preserve PPE for an anticipated spike in the pandemic. Dr. Jennifer Enos, president of the Arizona Dental Association, has also issued a statement asking “dentists to donate available supplies of personal protective equipment, such as medical gloves and masks,” which effectively would mean that dentists would need to close their offices until those supplies become generally available again.

Given all of this uncertainty, our attorneys have been receiving a host of questions from dentists who are trying to determine if they can file a disability insurance claim and/or how the coronavirus developments impact their disability claim/benefits. So, for the next several weeks our disability attorneys are going to dedicate our blog to answering dentist’s questions about coronavirus and disability claims under their private, own-occupation policies, in an effort to help the dental community be more informed on these important and complex legal/disability industry issues.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly

Sources:

ADA Calls Upon Dentists to Postpone Elective Procedures, American Dental Association, March 16, 2020, https://www.ada.org/en/press-room/news-releases/2020-archives/march/ada-calls-upon-dentists-to-postpone-elective-procedures.

UPDATE on COVID-19 , Arizona Board of Dental Examiners, March 19, 2020, https://dentalboard.az.gov/.

The Latest on COVID-19 from AzDA, Arizona Dental Association, https://www.azda.org/news-publications/the-latest-on-covid-19.

Utah Dental Association, https://www.uda.org/.

Hannah Tiede, Dental surgeons postpone elective procedures to combat COVID-19 spread, KOLD, March 18, 2020, https://www.kold.com/2020/03/19/dental-surgeons-limit-elective-procedures-combat-covid-spread/.

Hannah Miller, Dentists reduce hours, postpone elective procedures to combat coronavirus, CNBC, March 19, 2020, https://www.cnbc.com/2020/03/19/coronavirus-dentists-reduce-hours-postpone-elective-procedures.html.

Paighten Harkins, Some Utah dentists are closing because of coronavirus. Others don’t think they can., The Salt Lake Tribune, published March 17, 2020 (updated March 18, 2020), https://www.sltrib.com/news/2020/03/17/some-utah-dentists-are/.

 

Do I Lose My Disability Coverage If I’m Not Working?

It depends. Some disability policies (most often employer policies or group/association policies) have a requirement that you must remain “actively at work” or working “full-time” in order to stay eligible for coverage.

While sometimes “full-time” is defined, other policies, like the ADA/Great-West policy, have an hourly work requirement that must be met to maintain eligibility. For example, you may need to work 20 hours a week, or 30 hours a week, depending on the disability policy.

Many times, there are exceptions that can be utilized to maintain eligibility, but it may require further action, like obtaining a formal leave of absence from your employer or getting approval for FMLA leave. However, these are things that need to be done proactively, to preserve eligibility.

Additionally, if you lose eligibility and regain it later (say, after the national coronavirus epidemic has passed), this can re-set the coverage date and preexisting condition provisions under some policies. As a result, your claim could be denied on the basis that your disabling condition pre-dates the new coverage date, even if you technically regain the ability to file a claim under the policy upon returning to work.

There are certain legal principles that will work in tandem with the provisions of your policy, and that may help you, especially in circumstance like coronavirus pandemic. However, the administrators of your policy may or may not believe that it is in their best interest to voluntarily assist you, notwithstanding these laws.

Action Step: Locate your disability policies and become familiar with the requirements for maintaining eligibility. If necessary, take additional steps to preserve your eligibility during periods where you are not able to meet the normal hourly work requirements. Talk to a disability attorney if you have questions about ways to maintain your eligibility during the coronavirus crisis.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.

 

Can I File a Disability Claim if My Office Has Already Closed?

Yes, but your claim will likely receive heightened scrutiny—particularly if you worked normal hours seeing roughly the same number of dental patients up until your office was closed due to coronavirus.

Many disability policies require you to prove that your disability (or loss of income resulting from disability) was caused “solely” by an underlying sickness/injury, and not by other secondary causes. Other policies require you to show a “demonstrated relationship” between the disabling condition and your inability to practice dentistry. And some newer disability policies even exclude disabilities if they are “caused or contributed to” by something other than your underlying medical condition. If your disability policy contains such language, your insurer may deny or reduce your benefits on the grounds that your loss of income/inability to practice is due to causes other than your disabling condition.

Additionally, if you can’t work because you were forced to close your office or give away your supplies, or your employer sent you home and you can’t work for other dentists because of a non-compete agreement, your insurer may also try to use that as a basis to deny your claim.

This is called the “legal disability” defense and is usually used in situations where a dentist has legally lost the ability to practice—for example, if the dentist lost his/her license. Courts have addressed this differently in different jurisdictions, but generally the defense—where recognized—allows the insurer to avoid payment if it can show that you lost the legal ability to practice before you became disabled.

If your disability insurance company raises this legal defense, it typically results in a “chicken v. egg” scenario where your medical records and the timeline is parsed to determine what came first. And, while it is certainly possible to prevail, these claims may require court involvement to resolve—particularly if care is not taken at the outset to ensure that the timeline and facts are properly submitted with the original notice of claim.

Action Step: If you are considering filing a disability claim during the national coronavirus epidemic, recognize that your claim will be subjected to close scrutiny and make sure that you carefully review and double-check your responses when submitting your proof of loss to ensure that the timeline is accurate. If you are concerned about your insurer asserting a “legal disability” defense, speak with an experienced disability lawyer about your situation.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.

 

If I Close My Office Will That Hurt My Chances of Using My Disability Policy?

It could. See Can I File a Disability Claim if My Office Has Already Closed?

 

If I Change the Volume and/or Types of Procedures I’m Doing, Will that Hurt My Chances of Using My Disability Policy?

It could. While most policies sold to dentist are “own occupation” policies, the term “occupation” is a malleable term. Typically, “occupation” is defined as the “occupation or occupations” you were engaged in immediately prior to your date of disability.

As we’ve explained in our prior articles, this means that you can modify your occupation and hurt your chances of collecting if you change the types of procedures you are doing. If you reduce your hours, stop doing certain dental procedures and/or focus more on office administration and are not able to resume your normal schedule before filing a claim, your disability insurance company may determine your occupation is a “part-time dentist” and “part-time administrator,” determine that you can still do office administration, and refuse to pay total disability benefits.

Action Step: If you think that you may need to file a disability claim in the future, carefully weigh the risk of modifying your occupation against the risk of your future claim being evaluated based upon a modified occupation. If appropriate, consider filing a disability claim prior to pursuing non-clinical options, but discuss this first with an experienced disability insurance lawyer.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.

 

How Do I File a Disability Claim if I Can’t Get in to See My Doctor?

Most disability insurance policies require you to produce proof of loss within a limited time frame and state that the company can limit or deny providing you with disability benefits if you do not provide the information within that time frame. However, there are legal rules that allow for delay if it would be impossible or unreasonable for you to produce the proof within the required time frame.

These same exceptions also may apply in instances where you are already on claim and the disability insurance company is requiring an update from your doctor. Whether these exceptions are available to you will depend on what your policy says and the law in your jurisdiction.  An experienced disability attorney can help you request an extension if you need it.

Action Step. Speak with an experienced disability lawyer to assess whether it would be appropriate to file a claim and start the process prior to obtaining your doctor’s statement. If you are already on claim, ask for an extension and if the insurance company refuses to grant one, speak with a disability lawyer.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.

 

If I file a Partial Disability Claim How Do They Calculate Loss of Income? What If My Income Goes Down Because of Coronavirus?

Each disability insurance policy has a different formula for calculating prior income and loss of income. Some policies look to the year or 24 months immediately prior to date the disability claim was filed, other policies use averages over a several year period, and some policies give dentists the option to pick between the two.

Once your prior income is determined, it is typically averaged out on a monthly basis and compared to your actual monthly income to determine the loss of income, expressed as a percentage. If you meet a certain percentage loss, usually 15% or 20%, you are eligible for benefits.

If your disability policy averages out prior income over a period of several years, the impact on prior income will likely not be that significant if the drop in income dips for a few months and then recovers. However, if the policy looks to the period immediately prior to filing the claim, a series of a few months with little to no income could have a more drastic impact on how prior income is calculated. And if your prior income remains low when you ultimately file a partial disability claim, it becomes much harder to meet the threshold loss of income to qualify for partial disability benefits.

See also Can I File a Disability Claim if My Office Has Already Closed?

Action Step: If you are considering filing a partial disability claim, review your policy’s partial disability provision and become familiar with how “prior income” and “loss of income” are calculated under your policy. If you had a drop in income related a disabling condition prior to the loss of income from the coronavirus, and you are able to back that up with documentation, evaluate whether it would be appropriate under your policy to file partial disability claim based upon that loss of income.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.

 

Should I Try to File for Unemployment or Get Another Job Until I Can Go Back to Dentistry?

If you try to find another non-clinical job, you risk modifying your occupation. See If I Change the Volume and/or Types of Procedures I’m Doing Will that Hurt My Chances of Using My Disability Policy?

While unemployment benefits vary from state to state, barring significant changes to the programs, it is unlikely that these sorts of benefits will allow dentists to meet their expenses if dentists are forced to close their offices for extended periods of time. For example, in Arizona, the maximum weekly benefit is $240, or roughly $960/month. Additionally, there is a chance that the various programs will not be able to address the spike in people filing for benefits. In just Arizona alone, the non-partisan Economic Policy Institute released a new study showing that Arizona will lose more than 100,000 jobs by this summer related to COVID-19, including 4.2% of private sector jobs, which will place significant strain on the unemployment benefit program.

Obviously, you should not file a disability claim if you do not have a medical condition that limits you from practicing. However, if you are a dentist with a slowly progressive condition, like degenerative disc disease or an essential tremor and you have been considering filing a disability claim, your disability claim may be a better option than seeking unemployment benefits. While  there are some new considerations when filing a disability claim in this environment, your policy probably provides greater financial protection than unemployment benefits, if you have a legitimate disability claim.

Action Step: Learn more about your state’s unemployment benefits and how they compare to your disability policy’s benefits. If appropriate, consider filing a disability claim.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly

Sources:

Eligibility for Unemployment Insurance Benefits – How much will my weekly benefit amount be? https://des.az.gov/services/employment/unemployment-individual/eligibility-unemployment-insurance-benefits.

Steve Irvin, Analysis: Arizona will face huge job losses because of coronavirus, ABC 15, March 19, 2020
https://www.abc15.com/news/state/analysis-arizona-will-face-huge-job-losses-because-of-coronavirus.

Arizona increases access to unemployment benefits, moves tax deadline due to coronavirus, 12 News, March 20, 2020 (updated March 21, 2020)
https://www.12news.com/article/news/health/coronavirus/az-unemployment-benefits-tax-deadline-covid-19/75-d8a15335-2560-460c-89f2-1bdf7f52f412.

The Latest on COVID-19 from AzDA, Arizona Dental Association, https://www.azda.org/news-publications/the-latest-on-covid-19.

 

I Filed a Disability Insurance Claim Months Ago and Still Do Not Have a Decision – What Is Taking So Long?

While it is not unusual for a disability insurance company to take several months to make a benefits decision, it is important (and particularly important now) to be following up so that your disability claim is not placed on the back burner, particularly when insurers may be operating with limited staff.

If you feel your claim decision is being delayed, you have submitted all requested information, and you are in need of income for a particular reason (like the coronavirus) disability insurers will sometimes make advance payments under a “reservation of rights.” However, this money can be clawed back, so it is important to carefully evaluate whether this sort of thing is appropriate, and it may require the involvement of an experienced disability attorney to secure the advance payment.

Action Step: Be proactive and follow-up with your disability insurance company to determine when they will be making a benefits decision. If you feel that a decision is being wrongfully delayed, speak with a disability lawyer.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.

 

I Am Stuck Out of the Country and Can’t Get Back – Can My Disability Insurance Company Cut Off My Disability Benefits?

Some policies, particularly newer policies, contain “foreign residency” provisions that require you to be in the U.S. (or sometimes, the U.S., Canada or Mexico) in order to remain eligible to receive disability benefits. Oftentimes, the disability policy will allow for a certain period of time that you can be out of the country and then cut off benefits if you do not return.

At the same time, these provisions do not say what happens if your failure to return is due to something that is not your fault—like the coronavirus, quarantines or travel bans. Consequently, this is a difficult question that would likely hinge on the legal interpretation of the exact language in your policy, the law of your jurisdiction, and the court who is asked to resolve the issue, if the insurer is not willing to waive the terms of the contract or come to a compromise.

Action Step: Review your policy to determine whether it has a foreign residency provision. If it does and you are concerned that you may not be able to return to the U.S. in time to comply with its provisions, contact a disability lawyer.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.

 

My Insurer Says I Have to Undergo an IME But I Don’t Want to Get Coronavirus

Most policies contain provisions that require you to submit to medical examinations and allow the company to terminate benefits if you do not attend. Some policies only allow for a limited type of exams, while others contain provisions that go on for several paragraphs outlining the several types of tests and exams that the company can require. So the first step is assessing whether the exam that is being required is appropriate under the terms of your policy.

If so, then the second question is whether you should be forced to put your health at risk to secure or maintain your disability benefits. Again, this is something that may require the intervention of an experienced disability attorney to resolve, as it will likely initially require an in-depth assessment of whether the insurer can obtain the relevant information by other means. Other options include negotiating a postponement of the IME or, if the insurer is particularly aggressive, taking the insurer to court to determine whether these provisions are enforceable under these particular circumstances.

Action Step: If you are concerned about your insurer requiring an in-person IME, speak with a disability lawyer and have him or her evaluate whether the IME is required under your policy and whether there are other means to provide the requested information.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.

 

My Disability Insurance Company Wants to Send A Field Examiner to My House – Do I Have to Let Them In?

See My Insurer Says I Have to Undergo an IME But I Don’t Want to Get Coronavirus.

Most policies do require provisions that require you to submit to in-person examinations. However, there is also typically a “reasonableness” requirement. An experienced disability attorney can evaluate your claim to determine whether an examination is appropriate under the circumstance and/or whether there are alternative methods of obtaining the relevant information that do not place your health at risk.

Action Step: If you are concerned about your insurer requiring and in-person field interview, speak with a disability lawyer and have him or her evaluate whether the field exam is required under your policy and whether there are other means to provide the requested information.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.

 

I Can’t Get My Doctor to Complete My Disability Paperwork – What Do I Do?

See How Do I File a Disability Claim if I Can’t Get in to See My Doctor to get Claim Forms Completed?

Under certain circumstances it may be possible to request extensions and/or get the insurer to agree to accept proof of loss in other formats, such as medical records, test results, etc. However, it is important to be wary of the disability insurance company offering to do peer-to-peer calls with your doctor in lieu of reports.

Action Step. Ask for an extension and if the insurance company refuses to grant one, speak with a disability lawyer.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.

 

I’ve Been On Claim With Reduced Reporting and Now My Disability Insurance Company Wants to Do an Interview/IME – Is My Claim Being Targeted for Denial?

Historically, disability insurers have engaged in bad faith more frequently when they faced sustained periods of financial loss.  Additionally, during the last recession, we noted that many companies began revisiting claims that had been ongoing for years, and subjecting them to in-depths reviews to see if there had been any improvement or if they could find any basis for termination.

At the very least, disability claims—particularly high-dollar claims filed by dentists—are going to be receiving heightened scrutiny during this time. Field examiners, IME doctors, and other third parties who work with insurance companies, as well as the companies’ own analysts and in-house doctors conducting medical records reviews, will all be under substantial pressure to keep their jobs by saving costs for the insurance company.

Action Step: If you feel that your disability insurance company is improperly targeting your claim for denial, an experienced disability insurance attorney can help you assess your particular situation and determine whether the insurer’s action is appropriate.

Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly

 

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