See Residual Disability.
This is the maximum amount of total coverage an insurer will be willing to provide, after factoring in the coverage that you are already receiving from other insurance companies.
Click here for more information about participation limits.
The peer-to-peer call is a tactic used by insurance companies to deny or terminate claims. When you file your disability claim, the insurance company will typically assign your claim to a doctor who they pay to review your medical records and look for ways that they can deny your claim. Next, after you have submitted your medical records, the insurance company will say that it needs more information and tell you that its doctor will be calling your treatment providers over the phone to ask your doctor a few follow-up questions. The tone of these calls is usually collegial, to put your doctor at ease, and begins with a few straightforward questions. Once the insurance company’s doctor has developed a rapport with your doctor, he or she will then start to ask questions that are crafted to elicit responses that the company can use to deny or terminate your claim. For instance, the insurance company’s doctor might ask whether there are alternative treatment options, when your doctor thinks that you will be able to go back to work, etc.
After the call, the insurance company’s doctor generally sends your doctor a written summary of their discussion. These summaries often contain statements that are inaccurate and prejudicial to your claim, but your doctor may be too busy to notice and may simply sign off on it without much thought, inadvertently hurting your claim. The best way to prevent this from happening is to have all correspondence with your medical providers be in writing and go through an attorney.
Click here for more information about peer-to-peer calls and other tactics insurance companies use to deny and terminate claims.
Personal Disability Quotient (PDQ)
PDQ stands for “personal disability quotient.” Your PDQ estimates the likelihood that you will become disabled during your lifetime, based on a number of lifestyle and health factors.
Click here for more information about how to calculate your PDQ.
Physician Care Requirement
See Care Provision.
Pre-Existing Condition Limitations
Generally speaking, pre-existing condition is a physical or mental condition that existed before the effective date of the insurance coverage. Most policies exclude or reduce benefits for pre-existing conditions.
“Presenteeism” is a term used to describe the phenomenon of showing up to work in spite of illness, impairment, or disability that limits their productivity. Presenteeism is very common among physicians and dentists. Oftentimes, physicians and dentists will continue to practice in spite of physical limitations and/or alter their practices to accommodate their limitations, instead of filing for disability benefits. Sometimes, physicians and dentists will also start working in another capacity, such as an administrative position, or as a real estate agent, etc., to supplement their income. Continuing to work in spite of a disabling condition not only risks the safety of their patients and exposes them to malpractice liability, but also can make it more difficult to file for disability in the future, because they have demonstrated an ability to work in spite of their disability and, in many cases, modified the nature and scope of their occupation under the terms of their policy by reducing their duties or taking on new responsibilities.
Click here for more information about how presenteeism can negatively affect your disability claim.
Insurance companies often hire private investigators to investigate claimants, with the goal of gathering information that can be used to undercut a disability claim. Private investigators often employ multiple methods of surveillance, including following a paper trail, following and recording a claimant, pre-texting, and monitoring social media/web activity.
Click here for more information about surveillance methods used by private investigators during the claim process.
Punitive damages are a potential legal remedy in a bad faith lawsuit against an insurer. They are intended to deter the insurer from engaging in bad faith practices in the future, and can be substantial.