Panic Disorder

Dentistry is also not only one of the most hazardous jobs, it is also an incredibly stressful one. Unique stressors begin in dental school, with studies showing that in the final year of training, 67% of students had experienced possible pathological anxiety.[1]

Stressors only increase as a dentist enters clinical practice—including those found in the workplace, financial, practice management, and societal issues. In fact, dentists’ mental health has been shown to be poorer than that of those working in other professions.[2] The unique demands of the profession can unfortunately lead to serious mental health conditions that can interfere with the ability to practice safely. In this post will look at one such condition, panic disorder.

What Is Panic Disorder?

Panic disorder is an anxiety disorder that involves recurrent, unexpected episodes of sudden, intense anxiety (panic attacks). These episodes of overwhelming fear occur with no specific basis, and cause individuals to worry about future panic attacks and/or develop maladaptive changes in behavior related to the attacks. This fear of another attack can lead to avoiding situations and settings associated with past panic attacks.

An estimated 4.7% of U.S. adults will experience panic disorder at some point in their lives, with females at higher risk than males.  Those with the disease can suffer varying degrees of impairment, with the frequency of panic attacks varying from a few per year to daily. In some instances, panic disorder can become debilitating when the fear of having another panic attack interferes with the ability to carry out daily tasks and, in some instances, panic disorder presents with agoraphobia.

What Are the Symptoms of Panic Disorder?

Panic attacks typically happen unexpectedly and peak within several minutes. The symptoms of a panic attack can include:

  • Shortness of breath;
  • Pounding heart rate;
  • Chest pain;
  • Dizziness or lightheadedness;
  • Trembling or shaking;
  • Chills or hot flashes;
  • Sweating;
  • Headache;
  • Nausea or stomach ache;
  • Sensation of choking;
  • Feelings of being disconnected or unreal; and
  • Fears of losing control.

What Causes Panic Disorder?

The exact cause of panic disorder is not known, but experts believe certain factors can play a role, including:

  • Genetics;
  • Stress;
  • Temperament;
  • Changes in how the brain functions; and
  • Increased sensitivity to certain hormones that trigger excited feelings in the body.

What Are Treatments for Panic Disorder?

Panic disorder is most often treated with medication, typically anti-anxiety and/or antidepressant medications and counseling, including Cognitive Behavioral Therapy.

Panic disorder can prove debilitating, interfering with an individual’s ability to work, leave home, or carry out daily tasks. If you have been diagnosed with panic disorder and fear that it may be impeding your ability to continue to safely practice on patients, you should speak with an experienced disability insurance attorney.

It is especially important to speak with an attorney before making changes to your schedule and/or job duties or working in another field, because making changes like these could jeopardize your ability to collect, or continue to collect, benefits under the terms of your policy. Further, it is important to understand how any limitations or exclusions in your policy may impact a claim based on a mental health condition before making a claim.

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 above 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.

 

Sources:

National Institute of Mental Health

Johns Hopkins Medicine

Mayo Clinic

[1] Robert E. Rada, DDS, MBA, Charmaine Johnson-Leong, BDS, MBA, Stress, burnout, anxiety and depression among dentists, Journal of the American Dental Association, Vol. 135, June 2004.

[2] Id.

 

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Insurance Company Tactics:
Selectively Reviewing Claim Files

Most disability insurance companies request medical records as part of the claim investigation, in order to verify the disabling condition. However, an insurer intent on denying a claim may improperly cherry-pick certain medical records and ignore other records.

One such egregious example is the case of Watson v. UnumProvident Corp.[1] Valerie Watson, a legal secretary, become disabled in 1998, primarily due to heart disease and cardiac arrest. She began receiving benefits from UnumProvident under her policy, which provided she was totally disabled if she was unable to perform her own occupation. Her doctor, cardiologist Dr. Larry Perry, provided regular certifications to support Watson’s claim that she was disabled.

In mid-2000, UnumProvident (Unum) conducted a review of Watson’s case and, as part of this review, requested medical records, including Dr. Perry’s. In response to Unum’s request, Dr. Perry’s office inadvertently returned records for a “Valerie Johnson” rather than the actual records for Watson.

Remarkably, Unum did not request the correct records; instead, Unum determined Watson was no longer totally disabled and terminated benefits in November 2000. As Watson’s disability policy was subject to ERISA, she appealed the decision to Unum, and Unum rejected the appeal and denied her claim a second time (again, without requesting and reviewing the correct medical records).

When Watson sued Unum for denying her claim, the Court found that Unum improperly based its decision on “scant” evidence. In response to Unum’s protests that it had conducted a full and fair review, the Court pointed to Unum’s repeated failure to notice the fact that Unum had the wrong medical records and held that “viewed in full context, Unum’s behavior in this case was far more than mere negligent inattention to its important procedural and substantive responsibilities . . . it bordered on outright fraud” (emphasis added). The judge held that Unum’s failure to notice the records were actually the records of another patient served as conclusive proof that Unum had engaged in “an unprincipled and unreasonably review process in which it demonstrably looked only at selective records.”

This instance shows despite having a supportive doctor and detailed medical records, an insurance company may still deny or terminate a claim by ignoring (or not even looking at) medical records.

Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned that your claim has not received a full and fair review, an experienced disability insurance attorney can evaluate your claim and help you determine what options are available.

[1] Watson v. UnumProvident Corp., 185 F.Supp.2d 579 (D. Md. 2002)

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Unique Risk Factors in Dentistry

It is no secret that dentistry is hard work, and the unique physical demands of the profession can lead to health complications that may potentially result in a dentist having to leave his or her career earlier than anticipated and file a disability insurance claim. Top reasons for leaving dentistry include musculoskeletal disorders, cardiovascular disease, mental health symptoms (including anxiety and depression), tumors, and diseases of the nervous system.

At the top of the list are musculoskeletal disorders, which can include back pain, hand and wrist problems, and other related disorders. Signs and symptoms of musculoskeletal disorders include:

  • Loss of sensation;
  • Decreased range of motion;
  • Loss of coordination;
  • Loss of balance;
  • Tingling, burning or other pain in the extremities;
  • Numbness;
  • Weak grip or cramping hands; and
  • Clumsiness or dropping objects.

While each dentist’s symptoms and working conditions are unique, one study showed that 87.2% of dentists reported at least one symptom of musculoskeletal disease. While musculoskeletal conditions are common among dentists, they can also be among the hardest to prove up to insurance companies, due to the subjective nature of the many of the symptoms.

Below are some primary factors in the dentistry environment thought to contribute to musculoskeletal disorders:

  • Awkward postures increase stress on spinal disks and joints, especially when the back is bent or twisted during activities (compared to when the spine is straight).
  • Forceful exertions place a high load on muscles, tendons, ligaments, and joints.
  • Repetitive motions increase fatigue and muscle-tendon strain.
  • Extended duration increases the chances of both general and localized fatigue.
  • Contact stresses can create pressure on a specific part of the body, and inhibit blood flow and nerve function.
  • Vibrations may create change in the vascular, neural, and osteoarticular systems.
  • Psychosocial factors. Dentists with musculoskeletal conditions may also be more likely to have poorer psychosomatic health, and may be more likely to experience anxiety about hurting patients due to their limitations.

If you are considering filing a claim, an experienced disability insurance attorney can help you understand the terms of your policy and apply it to your particular situation.

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 above 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.

Sources:

Anshul Gupta, et al., Ergonomics in Dentistry, International Journal of Clinical Pediatric Dentistry, 2014 Jan-Apr; 7(1): 30-34.

Jamshid Ayatollahi, et al., Occupational hazards to dental staff, Dental Research Journal, 2012 Jan-Mar; 9(1): 2-7.

 

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The Evolution of Disability Policies
Part 7: Financial Examinations

In Part 7 of our series on how disability insurance policies have evolved, we’ll be taking a look at provisions related to financial examinations.

Most older policies give the company the right to request financial information from you, and say something along the lines of:

The Company may require proof, including income tax returns, of the amount of Earned Income for Periods before and after the start of disability.

Newer policies contain additional language that allow companies to be much more aggressive in what they can request, and can include provisions like:

We have the right, at our expense, to analyze or require an analysis of all relevant financial and operational records, including Your personal, business and corporate federal and state tax returns, as often as We may reasonably require by a financial examiner of Our choice. Such assessments may include analysis of business, financial, and operational records for any business in which You have or may have an ownership interest. We can require that Your accounting practices be the same as those which were in effect at the time You first became Disabled.

(emphasis added).

Further, many policies now have language that a claim can be denied or terminated if the requested audit of financial information is not provided. These provisions can be particularly onerous for professionals, who often have complex financial structures in place. And while, in certain instances, financial information may be relevant to a disability claim, these sorts of requests are sometimes used to engage in unwarranted fishing expeditions and/or as a tactic to delay making a claims decision. Consequently, it is important for professionals to approach requests for financial information in an informed manner.

Every claim is different, and these are just some examples of financial examination provisions taken from different policies. Your policy may contain different and/or additional language that could impact your particular situation.  If you are unsure about the terms of your policy, or how a provision applies to your specific situation, you should contact an experienced disability insurance attorney.

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Insurance Company Tactics:
Ignoring Evidence

When investigating a claim, most insurers will request proof of disability in the form of medical records and/or certifications from an insured’s treating provider(s). They also may have their in-house doctors perform a medical records review or conduct an independent medical examination of the insured. When an insurer is intent on denying a claim, they may go to great lengths to seek out conflicting opinions in an effort to ignore evidence proving a disabling condition.

The case of Kenneth R. Omasta v. The Choices Benefit Plan illustrates how some insurers are willing to ignore relevant evidence of disability.[1]  Omasta, a vice-president in a high-stress job, worked for his company for 22 years before becoming permanently disabled due to cerebral vascular disease, neurological deficits, and musculoskeletal disease. He filed for long-term disability benefits through his employer-sponsored Reliance policy and submitted certifications from five medical providers (his physicians, psychologist, speech pathologist and chiropractor), along with statements from supervisors and co-workers verifying his disability.

Instead of fairly considering the information submitted, Reliance determined it was insufficient and required Omasta to undergo an IME. Reliance selected Dr. Weight, a psychologist, to perform the IME, and used the IME as a basis for denying the claim in spite of the fact that Omasta had submitted opinions from multiple providers supporting his disability claim.

Omasta later sued Reliance and the Utah District Court reversed the denial of Omasta’s benefits, finding that Reliance’s decision was arbitrary and capricious. In doing so, the Court observed “[t]here is no information that Dr. Weight is in any way qualified to diagnose neurological disease or its symptoms” and concluded that Dr. Weight’s “opinion regarding Plaintiff’s malingering is unsupported by any other information in the record, and is contradicted by the opinions of his doctors, his former supervisors and co-workers and his long and successful employment history.”

This case, while ultimately decided in favor of the insured, shows the length insurance companies will go to deny professionals’ claims by selectively ignoring reliable evidence and turning a blind eye to readily available information.

Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned about how your claim is being administered, an experienced disability insurance attorney can help you assess your situation and determine what options, if any, are available

[1] Omasta v. The Choice Benefit Plan, et al., 352 F. Supp.2d 1201 (D. Utah 2004).

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The Evolution of Disability Policies
Part 6: Definition of Occupation

In Part 6 of our series on how disability insurance policies have evolved, we’ll be taking a look at provisions related to the definition of occupation.

Many older individual disability insurance companies defined “occupation” in a short, relatively straightforward manner. For example:

Your occupation means the occupation you are engaged in immediately preceding the onset of disability.

Since the policy defines occupation as what you are doing immediately before your disability, determining your “occupation” for purposes of your claim requires an assessment of your job and duties at the time you became disabled. This can be a complex evaluation if you have multiple jobs/sources of income or you have changed your schedule/duties.

Newer policies contain additional language and hurdles that can make occupational determinations even more complicated.  For example:

Regular Occupation means the occupation of the Insured at the time the insured becomes Disabled . . . . If the Insured is unemployed, retired, or not Gainfully Employed outside of the home for more than 15 hours a week at the start of Disability, the “Regular Occupation” of the Insured consists of the normal daily activities, including household duties, performed by the Insured at the time the Insured becomes Disabled.

This expanded provision could be especially problematic if, for example, you reduced your hours due to a disabling condition but did not file a claim.

Because the definition of “occupation” is so critical to how a disability claim proceeds, it is important for professionals to review their policies and understand how “occupation” is defined, especially before making any changes to work hours or job duties.

Every claim is different, and these are just some examples of how occupation is defined in different policies. Your policy may contain different and/or additional language that could impact your particular situation.  If you are unsure about the terms of your policy, or how a provision applies to your specific situation, you should contact an experienced disability insurance attorney.

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Non-Medication Treatments for Chronic Pain

Many of our clients experience disabling conditions that result in chronic pain. This can be especially true for dentists, as they are uniquely susceptible to musculoskeletal conditionsdegenerative disc disease, carpal tunnel, cubital tunnel syndrome, etc., due to the physical demands of their profession.

We’ve found that many of our clients who experience chronic pain are interested in exploring other options of dealing with the pain, beyond pain medications. At the same time, they often have difficulty researching other options due to their pain levels and the fact that many of these conditions make it extremely uncomfortable to be at a computer for extended periods of time.

To that end, we’ve put together a list of some of the treatment options some of our clients have looked into. This is not meant to be an exhaustive list, or a substitute for consulting with your doctor—it is merely meant to serve as a starting point for those who are looking into alternative treatments for chronic pain.

  • Ablation – a portion of nerve tissue is removed or destroyed in order to cause an interruption in pain signals and reduce pain in the treated area(s).
  • Acupuncture – very thin needles are strategically placed in the skin to interrupt pain signals.
  • Amnion allograft – an injection with amniotic components from a donated placenta, used with the goal of regulating the inflammation-healing cycle.
  • Biofeedback – a technique to learn to control some of the body’s functions. One type involves using an electromyograph to monitor the electrical activity that causes muscle contractions. The feedback received can help patients make changes in their body to help reduce pain.
  • Chiropractic Therapy – spinal manipulation with the goal of restoring mobility and providing pain relief for muscles, joints, bones and connective tissue.
  • Cryotherapy – exposure to extremely cold temperatures, with the aim of reducing inflammation and pain, and healing joints.
  • Injections or nerve blocks – local anesthetics, steroids, or other medications that are injected as a way to short-circuit pain. They can also be used diagnostically.
  • Physical Therapy – a physical therapist creates a specialized exercise/stretching program to try and relieve pain and increase function. Treatments such as taping, electrical nerve stimulation, whirlpools, heat, ice, and ultrasounds may also be used as part of the treatment regimen.
  • Platelet-rich plasma injections – a procedure where concentrations of an individual’s own platelets are injected, with the goal of accelerating the healing of muscles, tendons, ligaments, and/or joints.
  • Spinal Cord Stimulation (SCS) – a device that is surgically placed under the skin and sends a mild electric current into the spine to relieve pain.

For additional information on the risks and possible benefits of these treatments, you can visit the resources below and talk to your medical providers.

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 above 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.

Sources:

Mayo Clinic
John Hopkins
U.S. National Library of Medicine
University of Arizona
University of Utah

 

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The Evolution of Disability Policies
Part 5: Limitations

In Part 5 of our series on how disability insurance policies have evolved, we’ll be taking a look at provisions related to limitations on coverage.

Many older individual disability insurance companies contained exclusions or limitations on coverage relating to pre-existing conditions, but as time went on insurers also began to include additional limitations geared at a broader range of conditions, such as mental health, nervous conditions, and/or substance abuse.  For example:

Limitations For Mental Disorder And/Or Substance-Related Or Addictive Disorder. For each separate Disability that is primarily due to a Mental Disorder and/or a Substance-Related or Addictive Disorder, benefits will not be provided for more than 24 monthly benefit periods. . . “Mental Disorder” includes, but is not limited to, any psychiatric, psychological, psychotic, emotional, somatic stress, behavioral or personality disorder.

While this exclusion is pretty broad-reaching by itself, newer policies have expanded the scope of  limitations provisions even more, as the example below shows:

Limited Benefit Periods for Mental or Nervous Disorders. The Insurance Company will pay Disability Benefits on a limited basis during an Employee’s lifetime for a Disability caused by, or contributed to by, any one or more of the following conditions. Once 24 monthly Disability Benefits have been paid, no further benefits will be payable for any of the following conditions:

  1. Anxiety Disorders
  2. Delusional (paranoid) disorders
  3. Depressive disorders
  4. Eating disorders
  5. Mental illness
  6. Somatoform disorders (psychosomatic illness)
  7. Subjective Symptom Conditions

Subjective Symptom Conditions means any physical or mental or emotional symptom, feeling or condition which cannot be verified using tests, procedures or clinical examinations that conform to generally-accepted medical standards. Subjective Symptom Conditions Include, but are not limited to, headaches, pain, fatigue, stiffness, numbness, nausea, dizziness and ringing in ears.

(emphasis added).

This limitation provision is particularly broad, and has a catch-all for conditions based on symptoms that can’t be verified objectively, which can often be very difficult to do with certain disabling conditions. These provisions highlight the need to carefully review your policy applications to make sure you are getting the coverage you think you are, and the importance of reviewing existing policies to make note of any limitations on coverage you may face in the event you need to file a disability insurance claim.

Every claim is different, and these are just some examples of limitation provisions taken from different policies. Your policy may contain different and/or additional language that could impact your particular situation.  If you are unsure about the terms of your policy, or how a provision applies to your specific situation, you should contact an experienced disability insurance attorney.

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Utah Physicians Facing Unique
Mental Health Concerns Due to COVID-19

Doctors can be uniquely susceptible to mental health conditions like anxiety, panic disorder, and depression, and burnout due to the high-stress nature of their professions as well as the stigma around seeking treatment for mental illness. One study found that 46% of surveyed physicians reported burnout, with even higher rates in front line doctors (family medicine, general internal medicine, and emergency medicine).[1]

Two recent news articles out of Utah, found on NPR Utah and ABC4 News, discuss the growing mental health concerns the medical community faces, especially for those on the front lines in the fight against the coronavirus.

As Megan Call, a psychologist at the University of Utah’s Health’s Resiliency Center explained, the coronavirus is uncharted territory and she has been hearing from physicians and others that they are feeling emotionally exhausted, unable to connect with patients, and no longer feeling as if their work is worthwhile.  Call has been leading COVID-19 debriefing sessions for university medical staff, which serve as an opportunity for physicians and others to talk about how their work is impacting their mental health.

Support can be especially important when experiencing extreme stress and mental health conditions in the workplace, but coronavirus has made it difficult for physicians to reach out to traditional supports like family and friends, as they have had to physically distance themselves from loved ones in order to protect them.

During these difficult times, it is important for physicians to keep their own health and their patient’s health in mind, and not push themselves beyond their limits. If you are a physician struggling with mental health limitations, an experienced disability attorney can help you evaluate if it would be appropriate to consider a disability claim under the circumstances.

It is also important for physicians to seek help from mental health professionals and other avenues that remain available to them. For example, Dr. Morissa Henn, Community Health Director for Intermountain Healthcare (headquartered in Salt Lake City, Utah) recommends that healthcare workers focus on self-care, including through exercise, mindfulness activities, limiting exposure to news and social media, and confiding in people they trust.

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 above 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.

Sources:

Jon Reed, Doctors Already Face Mental Health Concerns – Coronavirus Isn’t Helping, NPR Utah, April 21, 2020.

Rosie Nguyen, Battling the mental health crisis for medical workers on the front lines of the COVID-19 pandemic, ABC4 News, April 28, 2020.

[1] Michael R. Privitera, et. al, Physician Burnout and Occupational Stress: An inconvenient trust with unintended consequences, Journal of Hospital Administration, 2015, Vol. 4, No. 1

 

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Insurance Company Tactics:
Misidentifying Claims

Insurers sometimes go to great lengths to avoid paying out on professionals’ claims for benefits under their disability insurance policies. This can include improperly designating a claim as a residual (or partial) disability when it is really a total disability claim.

One such example of this is the case of Morgan v. Unum Life Ins. Co. of America.[1]  Dr. Morgan, a general surgeon, had an own occupation policy, which was targeted to physicians and specialty-specific. After purchasing the policy, Dr. Morgan injured his hand was unable to continue practicing as a surgeon.

When Dr. Morgan filed for disability, Unum told him he did not qualify for total disability because he had performed some in-office procedures (what he termed “lumps and bumps”) and had performed a single major surgery in March 2007 (done prior to his own hand surgery, and before Unum considered Dr. Morgan’s disability on its merits).

Dr. Morgan sued to challenge Unum’s determination and, upon review, Utah District Court Judge David Nuffer found that “a reasonable jury could conclude that these minor office procedures were not part of Morgan’s surgical specialty.” The Utah Court further held that “the single major surgery . . . does not prove that Morgan could continue performing major surgeries on an ongoing basis.” The Court then went on to conclude that there was sufficient evidence to suggest that Unum did not conduct a proper total disability analysis and “instead decided to treat the claim as one for residual disability for purposes of convenience and to reduce its potential exposure.”

Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned that your insurer is not evaluating your claim under the proper standard, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.

[1] Morgan v. Unum Life Insurance Co. of America, No. 2:10-cv-957 DN., 2012 WL 3156569 (D. Utah Aug. 3, 2012)

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The Evolution of Disability Policies
Part 4: Medical Examinations

In Part 4 of our series on how disability insurance policies have evolved, we’ll be taking a look at provisions related to medical examinations.

Older policies typically contain pretty basic and limited language regarding examinations. For example:

Physical Examination. The Company, at its own expense, may have the Insured examined as often as reasonably necessary in connection with a claim. This will be done by a physician of the Company’s choice.

Newer policies are much more expansive and typically list off a wide-range of examinations and testing that the company can employ. For example:

Independent Medical Examination. We have the right to require medical examinations, functional capacity evaluations and/or psychiatric examinations in the evaluation of what benefits, if any, are payable. The examinations may include x-rays, blood and urine tests, psychological tests, and other tests or procedures that We deem reasonable to evaluate whether You continue to meet the definition of Disability. The examinations will be performed by a doctor or specialist We deem appropriate for the condition and will be conducted at the time, place and frequency we reasonably require, while You claim to be Disabled. We reserve the right to choose the examiners. The examinations will be paid for by Us. Such examinations may include any related tests that are reasonably necessary to the performance of the examination. We may deny or suspend benefits under the Policy if You fail to attend an examination or fail to cooperate with the examiner.

(emphasis added).

Going to an in-person exam conducted by a doctor chosen by (and paid by) the insurance company can be intimidating and some testing can be painful and uncomfortable—both physically and emotionally. Whether a request for testing is proper depends on the underlying medical condition(s) and the particular terms of your policy, and it is important to approach this process in an informed manner.

Every claim is different, and these are just some examples of examination provisions taken from different policies. Your policy may contain different and/or additional language that could impact your particular situation.  If you are unsure about the terms of your policy, or how a provision applies to your specific situation, you should contact an experienced disability insurance attorney.

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Acute Stress Disorder (ASD)

The high-stress demands of practicing can leave physicians and dentists uniquely susceptible to burnout and mental health conditions like anxiety and depression. This can be especially true for medical professionals on the front lines, responding to crises like the COVID-19 pandemic.

In this post, we are going to examine Acute Stress Disorder (ASD), another serious condition that can occur in environments where individuals are exposed to trauma.

What is ASD?

Acute Stress Disorder (ASD) is a trauma related disorder with an onset of three days to one month after experiencing a traumatic event, either through direct or indirect exposure. It is characterized by intrusive memories, changes in mood, and avoidance of associated stimuli.

Prevalence

While the prevalence rates of ASD vary due to multiple factors, including different types of trauma, the average is 19%. Females, those under 40, those with a history of past trauma and/or PTSD, those with other mental health conditions, and those who have a history of dissociative reactions to past traumatic events are more susceptible to ASD.

Symptoms

ASD is a temporary condition with symptoms that persist from three days to a month after a traumatic event, which cause clinically significant distress or impairment in functioning. Symptoms are divided into five categories and include:

  • Intrusion symptoms (re-experiencing the event through intrusive and distressing memories, dreams, or flashbacks).
  • Negative mood (inability to experience positive emotions).
  • Dissociative symptoms (an altered sense of reality or surroundings or of oneself/inability to remember an important aspect of the traumatic event).
  • Avoidance symptoms (efforts to avoid distressing memories, thoughts, feelings or external reminders associated with the traumatic event).
  • Arousal symptoms (sleep disturbances; irritable behavior and angry outbursts; hypervigilanc; problems with concentratio; exaggerated startle response).

Diagnosis

The diagnosis of ASD is based on history and an exam. A professional will screen for exposure to a traumatic event and an individual’s response to it, and may use screening tools such as The Acute Stress Disorder Structured Interview or The Acute Stress Disorder Scale. Practitioners will also rule out differential diagnoses, such as PTSD, adjustment disorder, traumatic brain injury (can occur concurrently), effects of medications and/or substance use, and other psychiatric illnesses.

Treatments

The goals of treatment are to reduce symptoms, increase functioning, and prevent the development of PTSD. Treatments include:

  • Psychotherapy, including Cognitive Behavioral Therapy (CBT)
  • Medications (antidepressants, anticonvulsants)
  • Mindfulness and other stress-management techniques

While some ASD cases will resolve without formal interventions, in other instances individuals will go on the develop PTSD.

While symptoms are similar to those found in PTSD, there are a few key differences including when a diagnosis can be made (PTSD symptoms must be present for at least a month). Further, criteria for PTSD includes non-fear-based symptoms (e.g. destructive behavior, exaggerated blame of self or others, feeling isolated) whereas ASD does not. PTSD includes a dissociative subtype, whereas depersonalization and derealization are included in the symptoms of ASD. Finally, PTSD requires meeting a certain number of symptoms within established clusters, while the symptoms of ASD are not classified within clusters (therefore an individual meets a diagnosis based on expression of symptoms in total).

Prevention

While it is often not possible to prevent a traumatic event, there are steps individuals can take to help prevent developing further complications, including consulting a professional following a traumatic event, seeking support, and getting treatment for any other underlying mental health conditions. For those who have jobs with a high risk of exposure to trauma (e.g. first responders or emergency room physicians), preparedness training may help.

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 above 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.

Sources:

Johns Hopkins Medicine
U.S. Department of Veterans Affairs, National Center for PTSD
Medical News Today

 

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The Evolution of Disability Policies:
Part 3: Authorizations

In Part 3 of our series on the evolution of disability insurance policies, we’ll be looking at provisions related to the authorizations insurers use to investigate disability claims.

Older policies typically contain a brief, more generic provision that mentions authorizations, such as this:

Authorizations. From time to time, the Company will furnish the Insured with authorizations to obtain and disclose information. These authorizations must be signed by the Insured and returned to the Company.

Newer policies seek to go far beyond that, and not only expand the language relating to authorizations, but also incorporate serious consequences for failing to execute authorizations. For example:

The applicant or insured Member will cooperate with the Company’s efforts to obtain this information and will execute any necessary releases or authorizations. The Company shall have the right to communicate with any accountants or other bookkeeping professionals, medical professionals, medical providers or other insurers.

Failure of an applicant or insured Member to cooperate with any of these requirements may, independently of other information provided, result in: (1) rejection of an application for insurance; (2) delayed benefit payments; or (3) denial, suspension or termination of benefits.

The Company’s decision to forego obtaining any particular information does not prevent it from subsequently requiring such information.

(emphasis added).

For frame of reference, here is an example of what these sorts of authorizations say:

I AUTHORIZE THESE PERSONS OR ENTITIES having any records or knowledge of me or my health to disclose that information to [insurance company]: • Physician, therapist, healer, or medical practitioner hospital, clinic, pharmacy, pharmacy benefit manager or other medical or medically related facility or association other health care provider insurance company or insurance support organization employer, business associate, group health plan, or plan administrator motor vehicle or driver licensing agency, law enforcement agency, or other government agency agency, organization or entity administering a benefit program, educational, vocational or rehabilitation organization or program consumer reporting agency, financial institution, accountant, tax preparer or other persons or institutions

As you can see, these authorizations can be extremely broad in scope. Sometimes the requested information is relevant to the underlying claims investigation, but in other instances the company may just be fishing for additional information about you that has little to no bearing on the nature of the claim being made.

Whether or not a request is proper often depends on the particular facts and circumstances and policy definitions in play, so it is important for you to read your policy carefully and become informed about the how the claims process works.

Every claim is different, and these are just some examples of authorization provisions taken from different policies. Your policy may contain different and/or additional language that could impact your particular situation.  If you are unsure about the terms of your policy, or how a provision applies to your specific situation, you should contact an experienced disability insurance attorney.

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

Physicians across the country are experiencing heightened levels of anxiety and stress in the face of the coronavirus pandemic. They are bracing for a spike in cases that the U.S. healthcare system will not be prepared to face, and some are already running out of supplies. Others are working in hospitals that are short-staffed, tending to both sick and anxious patients. And many physicians are balancing their desire to help patients with the risk of becoming a potential sources of contagion to their loved ones and community.

One doctor described this unique type of stress as “pre-traumatic stress disorder” as doctors brace for an outbreak that seems inevitable.[1] Another doctor observed “[m]ost physicians have never seen this level of angst and anxiety in their careers.” [2]

These unprecedented stressors can have a significant impact on physicians already dealing with mental health issues like depression, anxiety, panic disorder, or similar conditions. Physicians currently are experiencing increased distress and worry over physician shortages[3], shortages of supplies[4], and fears of becoming ill and/or quarantined themselves.

Organizational psychologist Adam Grant, in a piece in The New York Times, also recently explained that over half of doctors experience “burnout,” and risks of stress/burnout become even “more acute” during a pandemic because medical professionals are “braving high disease exposure, long hours and inadequate resources.”[5]

Even for those physicians not on the front lines, this pandemic has drastically impacted their bottom lines and work schedules as they have to postpone procedures, and potentially cut back on hours or close their practices entirely to preserve personal protective equipment (PPE). However, as we’ve noted in prior posts, unemployment programs typically do not provide high enough benefits for doctors to meet their obligations and expenses.[6]

In light of all of this uncertainty, many physicians have been reaching out to us to see if it is possible to file disability claims under their own-occupation disability policies. We’ve answered the most common questions we’ve been receiving from doctors, below, and will be updating this post throughout the coronavirus crisis as we receive more questions from physicians.

Each physician’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 medical community and answer physician’s 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 Claim for “Burnout”?

It depends on what you mean by “burnout,” and whether you have an actual, underlying mental health condition that has been treated by a mental health professional. Most disability policies require you to provide evidence of either a “sickness” or an “injury” that prevents you from being able to perform the material and substantial duties of your occupation.

If you file a claim based on increased stress levels and fatigue and label it “burnout,” we’ve seen insurers seek to minimize these things as “just part of the job,” determine that this does not qualify as a disabling condition and deny the claim. Some policies also specifically exclude coverage for mental health conditions, or limit benefits for mental health claims to a shorter time frame (usually around 24 months). So the first step is to determine whether your policy provides coverage for mental health claims.

If your policy covers mental health claims and you have a diagnosed condition, it is possible to file a disability claim; however, mental health claims are also some of the most challenging disability claims. They receive a high level of scrutiny, and can be difficult to prove up since most mental health conditions are diagnosed based upon subjective symptoms that are reported to your treating providers.

As a result, insurer’s medical consultants and in-house doctors often challenge and second-guess the diagnoses and treatment plans submitted by your providers. Oftentimes, an insurer will suggest more aggressive treatment because they want you to go back to work so they can save money. But if work is a trigger for you, that may not be in the best interest of your mental health.

Additionally, while some policies expressly require you to pursue treatment that would lead to a “return to work” and/or “maximum medical improvement,” other policies simply require you to be under the “regular” care of a provider, or require you to receive “appropriate” care. Where your policy falls on this spectrum typically informs how aggressive an insurer will be about challenging your treatment, and if there is a disagreement over whether a certain treatment is required by your policy, it may require the intervention of a disability insurance attorney and/or court involvement to resolve.

Our office has dealt with these issues before and has helped numerous professionals successfully navigate their mental health claims. While it can be a difficult process, it is possible to collect, if you have a legitimate mental health condition, an understanding of how your policy works and supporting documentation of your condition.

For a more detailed discussion of the challenges physician’s face when filing mental health claims, see our article in MD Magazine, “Can You Collect Disability Benefits For Burnout?

Each physician’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 medical community and answer physician’s 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 a High-Risk Individual. Can I File a Disability Claim if My Office Environment Places My Health at Risk?

This is an interesting legal question that has not been fully developed in the context of a national pandemic. Most legal questions are resolved by consulting precedent and since, in many ways, the current COVID-19/coronavirus in unprecedented (particularly in the last 30 or so years when private disability insurance policies for professionals have been the most prominent) this is a open question that would likely require a disability lawyer and court involvement to resolve.

The strength of this sort of claim would largely depend on the physician’s specialty, the underlying policy, and the law of the jurisdiction in question. While most disability policies do not directly address what happens if there is a national epidemic, like the coronavirus, some policies do address situations that could be pointed to by analogy.

For example, some physician policies have riders that state that the company will recognize disability if the physician contracts a sickness or disease that could place the physician’s patients at risk (for instance, if a physician tests positive for HIV and there is a risk that the virus could be transmitted to patients in the course of the physician’s normal duties). If a physician has coronavirus, one could argue that practicing similarly places patients at risk and arguably falls under this sort of rider.

There is a fundamental difference, however, because the coronavirus is not something that is normally expected to be contagious for an extended period of time. If it is something that passes in a few weeks, then it is unlikely that any benefits would be due, because most policies require the disability to last for a specific elimination period before benefits are payable, and those waiting periods usually last at least three months (or longer).

Looking at it from another perspective, some courts have held that a physician should be considered disabled if the physician’s work environment places the physician’s health at risk. For example, if a physician were diagnosed with a heart condition and the stress and demands of practicing could cause a heart attack, a court might recognize such a condition to be totally disabling. By analogy, if a physician’s health were at risk due to coronavirus, one could argue that the physician is disabled from practicing for as long as that risk is present.

Again, these are untested waters, and there is no guarantee that a court would approve such a disability. Most likely, if the risk were just the general risk of contracting coronavirus, we expect that the insurer would deny the claim and a court would most likely uphold the denial. However, if there is an underlying health condition that places the physician at heightened risk of mortality if exposed to coronavirus (for example, the physician had a compromised immune system due to another condition, like leukemia) courts may be more sympathetic and more willing to recognize disability.

Each physician’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 medical community and answer physician’s 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 Focus and Am Afraid I’m Going to Hurt Somebody. Can I File a Claim?

If you are a physician and your ability to focus and think critically is compromised, you may qualify for disability benefits. However, mental health claims are often subject to policy exclusions and limitations, and are some of the most difficult claims to make.

For frame of reference, our physician clients who have filed claims for anxiety typically have a history of panic attacks that were non-responsive to treatment. Their specialties required a high degree of attention to detail and critical thinking, and often there is an underlying event or specific trigger that is work-related. Additionally, they take medication for their condition and that medication impacts their ability to think clearly and concentrate to a degree that it is not possible for them to safely practice their specialty when they are taking the medication.

So, in sum, whether you can file a claim depends on factors such as the severity of your condition, whether you have a history of receiving treatment for the condition, whether the anxiety is triggered by something that is work/occupation related,  whether you are taking medication for the condition, and the nature of your specialty and job duties.

See also Can I File A Claim for “Burnout”?

Each physician’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 medical community and answer physician’s 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 Have Had to Isolate from My Family Because I’m Afraid to Get them Sick. Can I File a Claim for Depression?

If you are a physician suffering from severe depression, to the point where you would be putting patients at risk by practicing, you may be able to file a disability claim, as long as your policy provides coverage for mental health conditions.

As with a disability claim based upon anxiety/panic disorder, whether you can file a claim depends on factors such as the severity of your condition, whether you have a history of receiving treatment for the condition, whether the depression is triggered by something that is work/occupation related, whether you are taking medication for the condition, and the nature of your specialty and job duties.

See also Can I File A Claim for “Burnout”?

Each physician’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 medical community and answer physician’s 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.

References:

[1] Alison Block, Doctors and nurses are already feeling the psychic shock of treating the coronavirus, The Washington Post, March 18, 2020, https://www.washingtonpost.com/outlook/2020/03/18/doctors-nurses-are-already-feeling-psychic-shock-treating-coronavirus/.

[2] Karen Weise, Doctors Fear Bringing Cornavirus Home: ‘I am Sort of a Pariah in My Family’, The New York Times, March 16, 2020 (updated March 17, 2020), https://www.nytimes.com/2020/03/16/us/coronavirus-doctors-nurses.html.

[3] Stephanie Innes, Number of hospital beds, doctors in Arizona are low compared with rest of U.S., Arizona Republic, March 15, 2020 (updated March 16, 2020), https://www.azcentral.com/story/news/local/arizona-health/2020/03/15/number-hospital-beds-doctors-arizona-low-compared-rest-u-s/5038216002/.

[4] As an example, The Utah Department of Health, according to a news article in The Salt Lake Tribune, announced on March 24th a halt to nonurgent medical, dental, and veterinary procedures in order to preserve protective gear for health professionals. The order currently runs through April 25th. See Sean P. Means, Lee Davidson, Bethany Rodgers, Utah increases COVID-19 testing, halts non-urgent care – but some doctors urge stay-at-home orders, The Salt Lake Tribune, March 24, 2020, https://www.sltrib.com/news/2020/03/24/utah-increases-covid/.

[5] Adam Grant, Burnout Isn’t Just in Your Head. It’s in Your Circumstances, The New York Times, March 19, 2020, https://www.nytimes.com/2020/03/19/smarter-living/coronavirus-emotional-support.html.

[6] For example, the maximum weekly unemployment benefit insurance in Utah is $580, with a total maximum benefit of $15,080.00.

See Unemployment Insurance Benefit Schedule, January 2020, Workforce Services Unemployment Insurance, https://jobs.utah.gov/ui/UIShared/PDFs/BenefitCalculation.pdf.

 

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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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Dentistry Tops List of Most Dangerous Jobs

Business Insider has ranked dentistry as one of the most dangerous professions for your health, for multiple years in a row. In their most recent report, dentist was listed as the second most dangerous out of 32 occupations—outranking firefighters, mine shuttle car operators, and nuclear equipment operation technicians. Dental laboratory technicians, dental hygienists, prosthodontists, and dental assistants took the first, third, fourth, and seventh spots, respectively.[1]

The report looked at seven high exposure factors, including exposure to contaminants; exposure to disease or infections; exposure to hazardous conditions; exposure to hazardous equipment; exposure to minor burns, cuts, bits or stings; exposure to radiation; and time spent sitting. Dentistry’s highest risk factors were exposure to disease of infections, exposure to radiation, and time spent sitting.

In addition, dentists are uniquely susceptible to musculoskeletal conditions (such as degenerative disc disease, carpal tunnel syndrome, and osteoarthritis) due to the demands of the profession. Over time, these physical demands can eventually lead to chronic and slowly progressive conditions that may result in a dentist becoming disabled for some portion of their career.  In fact, one study listed musculoskeletal disorders as the top reason that dentists leave the profession early.[2]

Given these risks of the trade, dentists should review their disability policies carefully and have a transition plan in place well before filing a claim to ensure they do not unwittingly jeopardize their ability to collect benefits. If you are a dentist considering filing a claim, an experienced disability insurance attorney can help you understand the terms of your policy and apply it to your particular situation.

 

[1] Andy Kiersz, The 32 most dangerous jobs for your health, Business Insider, March 8, 2019.

[2] Anshul Gupta, Ergonomics in Dentistry, International Journal of Clinical Pediatric Dentistry, 2014 Jan – Apr; 7(1): 30-34.

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The Evolution of Disability Policies
Part 2: Interviews and Examinations

In Part 2 of our series on how disability policies have evolved over time, we’ll examine provisions related to personal interviews and in-person examinations.

Most older policies give the company the right to interview you, and say something along these lines:

Personal Interview. The company may conduct a personal interview of the Insured.

Newer policies, however, are much more aggressive and can include statements like:

Examinations. You must meet with Our representative for a personal interview or review of records at such time and place, and as frequently as We reasonably require.

or:

We must be provided with satisfactory proof of loss. If the proof of loss requirements We request are not received, the claim will be denied. Proof of loss requirements include, but are not limited to:

      • A personal interview with a company representative, which may include a statement under oath.

Sometimes these interviews are conducted over the phone, sometimes on a recorded line, and other times the company will send a field examiner out to interview you in-person at your home or office.

These interviews are often a critical factor in whether a claim is accepted or denied, and should be taken seriously—particularly if the statements are being made under oath.

Every claim is different, and these are just some examples of examination provisions taken from different policies. Your policy may contain different and/or additional language that could impact your particular situation.  If you are unsure about the terms of your policy, or how a provision applies to your specific situation, you should contact an experienced disability insurance attorney.

 

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Insurance Company Tactics:
Ignoring Treating Physician Evidence

In most disability claims, insurance companies begin their investigation by requesting a report from your treating physician, along with medical records. However, if they are not happy with the treating physician’s opinion, they may turn to other tactics.

The case of Card v. Principal[1] is one example. In February 2013, registered licensed practical nurse Susan Card was diagnosed with chronic lymphocytic leukemia. Initially the condition was asymptomatic, but increasingly she began to experience worsening fatigue. She reduced her work hours and ultimately had to stop working altogether as her symptoms worsened. Card’s primary care physician noted her fatigue, easy exhaustion, chronic vaginal bleeding, feelings of depression and being wiped out, and night sweats, concluding that “she is failing work because of her disease and needs to go out on disability.” But in spite of all this, Principal denied her claim.

Due to increasing financial struggles, Card had to move states to live with her sister, having lost her house to foreclosure. Her primary care physician again informed the insurance company of Card’s inability to work and explained that, while her blood work looked better because she was no longer working, she was still dealing with chronic fatigue. He continued, “I do not see her being able to have any work capacity.” Her treating doctor then instructed her to follow up with new doctors upon her move. Card found a specialist in hematology and oncology and a gynecological oncologist, once she was able to find specialists that accepted medicaid. Card also appealed the initial denial but, again, Principal denied her claim in spite of her treating doctor’s statements that she was disabled.

In doing so, Principal essentially ignored Card’s doctor’s statements and justified their denial, in part, by claiming that Card had not submitted documentation that she was “under the regular and appropriate care of a physician” as required under the terms of her policy (Card’s policy, like most policies, contained a care provision, which establish additional requirements for qualifying for benefits).  However, in this instance,  Card’s physicians had told her that further appointments were not necessary in the months after her diagnosis (as is common in the early stages of chronic lymphocytic leukemia, given the nature of the disease).

Upon review, the Court found that none of the reviewers had adequately addressed Card’s specific health issue against the actual demands of her job (i.e. she could not be exposed to pathogens), nor addressed their reasoning for ignoring Card’s treating providers’ evidence and recommendations for the course/frequency of her treatment. The Court held that, while Principal was not required to give more weight to a claimant’s treating provider’s opinion, insurance companies cannot arbitrarily refuse to consider that opinion. The Court remanded the case, concluding that Principal’s decisions were not “the product of a principled and deliberative reasoning process.”

In this instance, Card  was fortunate to have had supportive physicians who documented her condition and why she could no longer work in her previous occupation. However,the Court ultimately had to step in to make sure Principal did what was right, demonstrating that sometimes supportive physicians and evidence may not be enough avoid a claim denial.

Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If your policy’s terms are not what you expected, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.

[1] Card v. Principal, No. 2019 WL 5618182 (U.S. Ct. of App. 6th Cir. Oct. 31, 2019)

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The Evolution of Disability Policies
Part 1: Care Requirements

In this series, we will be examining how insurance companies have changed disability policies over time to make it harder to collect benefits. In Part 1, we’ll be looking at care provisions.

Most disability policies require you to be receiving ongoing medical care in order to remain eligible for ongoing benefits. Earlier disability policies typically addressed this requirement in a short, simple manner. For example:

Benefits are provided for the Insured’s total or partial disability only if:

      • the Insured is under the care of a licensed physician other than himself during the time he is disabled

In contrast, newer policies (particularly those sold to dentists, physicians, and other professionals) now have much more stringent care requirements.  For example:

REGULAR CARE BY A DOCTOR – means:

        • You are evaluated in person by a Doctor; and
        • You receive treatment appropriate for the condition causing Your Disability; and
        • Your evaluations and treatment are provided by a Doctor whose specialty is appropriate for the condition causing your Disability; and
        • The evaluations and treatment must be at a frequency intended to return You to Full Time Work; and
        • You must pursue reasonable treatment options or recommendations to achieve maximum medical improvement.

(emphasis added). In addition, some policies hide additional caveats related to your care in other parts of the policy. For example, a policy that contains a definition of “regular care” could also have a “duty to cooperate” provision in another part of the policy that states something like this:

You have a duty to cooperate with us concerning all matters relating to this policy and any claims thereunder. This cooperation includes, but is not limited to . . . 

          • securing appropriate medical treatment for condition(s) upon which your claim for benefit under this policy is based. This includes such corrective/remedial surgery or generally accepted medical procedures which to an ordinarily prudent person would appear medically reasonable for such condition(s).

(emphasis added). When you consider these provisions along with the fact that most disability policies allow your insurance company to request in-person medical examinations, you can see that filing a disability claim is not as simple as finding a doctor to sign off that you are disabled. The process is much more involved than that. In addition to being prepared to back up your diagnosis and limitations, you should be prepared for challenges to your doctor’s treatment plan (and be able to explain why you are not complying with your doctor’s recommendations, if there is a recommended treatment that you are not pursuing).

Every claim is different, and these are just some examples of care provisions taken from different policies. Your policy may contain different and/or additional language that could impact your particular situation.  If you are unsure about the terms of your policy, or how a provision applies to your specific situation, you should contact an experienced disability insurance attorney.

 

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Utah’s Physician Shortage

Experts with the American Association of Medical Colleges anticipate a shortage of 122,000 physicians by 2032, with the possibility that historically underserved areas may experience these shortages more acutely, both in primary and specialty care.

Utah, as with many states, is a part of this trend. Specifically, the U.S. Department of Health estimates that there will be a shortage of 600 primary care physicians by 2025. Currently, 26 of Utah’s 29 counties have shortage areas, and 18 are underserved for dental providers (shortage areas are defined as those that have 3,500 people or more to one doctor). As a result, some physicians and dentists are having to take on heavier workloads, which can make them more susceptible to disabling injury or illness, including mental health conditions like anxiety and depression.

Utah is taking steps to address this shortage, in part by establishing the Healthcare Workforce Financial Assistance Program and the Rural Physician Loan Repayment Program, which offer student loan repayments to physicians, dentists, and mid-level providers who agree to work in underserved areas. Because clinics in underserved areas, whether they be rural or urban, tend to pay less on average, experts hope the offer of loan repayment will incentivize residents and doctors to consider and accept jobs in these sectors, and hopefully choose to stay on once their obligation period passes.

Sources:

Ashley Imlay, Doctor shortage brings creative solution: Work here and we’ll help pay your student debt, Deseret News, Oct. 27, 2019
Utah Department of Health
Public Health Indicator Based Information System (IBIS), Utah’s Public Health Data Resource

 

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