Study Shows Impact of long COVID on Physicians

A recent study by the British Medical Association (BMA) looked at physicians with long COVID and found that nearly one in five were no longer able to work, and fewer than one in three was working full-time. Further, nearly half of the responding physicians said they had lost income as a result of long COVID.[1]

The British doctors reported their symptoms included fatigue, headaches, muscle pain, nerve damage, joint pain, and ongoing respiratory pain, with a majority (54%) acquiring COVID during the first wave of the pandemic. Of these, 77% believed they had contracted the disease while at work.[2]

Similar employment trends for those with long COVID have been seen in the United States. In a study published by the JAMA Network Open, of 15,308 adults surveyed between February 2021 and March 2022 with test-confirmed COVID-19, those with long COVID (also called post-COVID-19 condition, or PCC) were less likely to be employed full-time and more likely to be unemployed. Of those reporting long-COVID, 45.9% reported either brain fog or impaired memory. [3]

A recent New York Times article reported that, according to one study published by New York’s largest workers’ compensation insurer, 71% of people classified as experiencing long COVID either required ongoing medical treatment or were unable to work for six months or longer. Eighteen percent of long COVID patients had not returned to work more than a year after contracting COVID (and more than three fourths of these individuals were under the age of 60).[4]

For physicians, dentists, and other professionals suffering from long COVID, the impact on their career and livelihood can be significant, and they may need to file a disability insurance claim. These types of claims have unique challenges and are often contested by insurance companies. As we’ve written about before, long COVID claims need the support of treating physician(s) and strong medical records —especially given that there is no one definitive, objective test for long COVID, and the duration of long COVID can vary greatly.

If you’ve been diagnosed with long COVID and feel you may need to file a disability insurance claim, please feel free to reach out to one of our attorneys directly.

[1] Adele Waters, Long covid: nearly half of doctors affected can no longer work full time, finds survey, BMJ 2023;382:p1529.

[2] Id.

[3] Roy H. Peerlis, MD, MSc, et. al, Association of Post-COVID-19 Condition Symptoms and Employment Status, JAMA Netw Open. 2023;6(2):e2256152.

[4] Pam Belluck, Long Covid Is Keeping Significant Numbers of People Out of Work, Study Finds, The New York Times (Jan. 24, 2003).

 

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Long COVID: A Case Study

Some people infected with COVID-19 may go on to experience long COVID, which can cause a wide range of health issues that can last anywhere from several weeks to even years.  Symptoms vary widely and can include fatigue, respiratory and heart symptoms, neurological symptoms, fever, joint pain and/or muscle pain.

Those afflicted with long COVID may find themselves unable to work and needing to file a long-term disability claim.  However, it can be difficult to prevail on these types of claims, as insurers will often try to get out of paying claims based on long COVID.

One such example is the case of Abrams v. Unum.[1] Here, plaintiff William Abrams was an appellate lawyer who was experiencing “brain fog, fatigue, decreased attention and concentration, and fevers” starting in April 2020. After Unum initially denied his claim, Abrams appealed and went to seven different medical doctors, three of whom diagnosed plaintiff with long COVID with the remaining four diagnosing him as having chronic fatigue syndrome (CFS).

Unum continued to deny his claim, stating that a mental status exam did not show the necessary cognitive deficits needed to confirm the diagnosis of CFS, and that he had not submitted enough proof that he suffered from long COVID.  While the Court agreed that there may be a paucity of evidence to confirm a diagnosis of long COVID, they pointed to the fact that all of Abrams’s providers confirmed that he was indeed sick and unable to meet the demands of his prior occupation.

The Court explained that “[b]eing a trial lawyer is akin to writing, directing, producing, and starring in a play simultaneously. The work is mentally and physically grueling. A reviewer must take that complexity into account when reviewing a claim.”  The record shows that prior to his illness, Abrams was an avid marathon runner and worked 12-hour days. However, after his illness commenced, his primary care doctor noted that Abrams would “not be able to put together 1-2 workdays or partial workdays in a given week.” The Court further noted that if Abrams could not follow movie plots, he “cannot be expected to plan out trial strategies for multiple, complex cases.”

While Abrams was ultimately successful with his claim, the matter required costly and time-consuming litigation before the matter was resolved in his favor. This case highlights the challenges those with long COVID face when trying to collect benefits, and the need for strong medical records and supportive physicians. If you are experiencing long COVID and feel that you might need to file a claim, please feel free to reach out to one of our attorneys directly.

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] Abrams v. Unum Life Ins. Co., C21-0980 TSC, 2022 WL 17960616 (W.D. Wash. Dec. 27, 2022).

 

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Long COVID and Disability Insurance Claims
Part II

Our previous post looked at the symptoms and diagnosis of long COVID, which may lead to the need to file a disability insurance claim.  While long COVID can now be considered a disability under the Americans with Disability Act (ADA), your disability insurer may not recognize long COVID as a disabling condition (in fact, some newer policies are being issued with a “post-viral syndrome” limitation).

Part of the reason insurers have been successful in avoiding paying out claims based on long COVID is that there are no tests to diagnose post-COVID conditions.  According to the CDC[1], post COVID’s symptoms could be attributable to other health problems.  Further, results from blood tests, chest x-rays, and electrocardiograms may be normal. For example, many symptoms reported by long-haulers can mimic those of chronic fatigue syndrome, another condition that is notoriously hard to prove up, and one which may be subject to a subjective conditions limitation found in some disability insurance policies.

When filing a disability insurance claim for long COVID, it is important to have a supportive physician(s) who can document both symptoms and a diagnosis in medical records.  Your physician(s) will also likely need to submit ongoing paperwork to your insurer, to continue to document your condition, throughout the duration of your claim.  It may also be necessary to submit additional evidence backing up your claim.  This could include a functional capacity examination (FCE) or neuropsychological exam—both of which can be used to demonstrate any limitation you may be experiencing that prevents you from working in your profession.

If you are suffering from long COVID and feel that you might need to file a claim, please feel free to reach out to one of our attorneys directly.

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.

[1] Long COVID or Post-COVID Conditions, Center for Disease Control and Prevention, updated June 17, 2022

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Long COVID and Disability Insurance Claims
Part I

As more time passes in the pandemic, it is clear that people experience COVID differently.  While some may be clear of the virus within a few weeks, others who have been infected may go on to experience long COVID (also called long-haul COVID, post-COVID and post-acute COIVD).  Just like acute COVID, long COVID can cause a wide range of health issues that can last several weeks, months or even years.

According to the CDC[1], symptoms can vary person to person, but can include the following:

  • Feelings of tiredness or fatigue that interfere with daily life;
  • Post-exertional malaise
  • Fever
  • Respiratory and heart symptoms (chest pain, cough, difficulty breathing or shortness of breath)
  • Neurological symptoms (sleep problems, headache, dizziness, brain fog, depression or anxiety)
  • Digestive symptoms (diarrhea, stomach pain)
  • Joint or muscle pain
  • Rash
  • Changes in menstrual cycles

According to the Mayo Clinic[2], risk factors for long COVID include:

  • Having severe illness with COVID-19 (especially if hospitalized or needed intensive care)
  • Having certain pre-existing medical conditions
  • Having a condition that affected organs or tissues while sick with COVID-19 or afterwards
  • Are an adult

While these are identified risk factors, anyone who has had COVID-19 can have long-term effects—even those with mild illness or no symptoms.

Because long COVID can last a significant period of time, those with it may need to file a long-term disability claim; however, we’ve seen insurers balk at paying such claims.  Our next post will look at filing a disability insurance claim for long COVID in more detail.  If you have been diagnosed with long COVID and are considering filing a disability insurance claim, please feel free to reach out to one of our attorneys directly.

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.

[1] Long COVID or Post-COVID Conditions, Center for Disease Control and Prevention, updated June 17, 2022

[2] COVID-19: Long-term effects, Mayo Clinic, June 28, 2022

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Can I File A Claim For Long-Haul COVID?

COVID-19 was uncharted territory in many aspects of our lives, and disability insurance claims are no different.  Most individual disability insurance policies have an elimination period (often 90 to 180 days) that makes it difficult to file a claim based upon the COVID-19 infection itself.  But what about situations where COVID-19 complications result in long-haul symptoms and limitations?

What is Long-Haul COVID?

Long haulers (also referred to as COVID-19 syndrome or long COVID) are individuals whose symptoms of COVID-19 don’t go away, at least entirely.  Lingering health problems can last for months.  The most common lasting symptoms are fatigue, shortness of breath, cough, joint pain and chest pain.  Other complications can include breathing issues, heart problems, kidney damage, lost or distorted sense of smell and taste, neurological problems, autonomic nervous system symptoms, blood clots, mental health issues, and diabetes.  Further, many long-term effects remain unknown as researchers continue to study the disease.

Long-Haul COVID’s Impact On Doctors Ability to Work

As you can imagine, these complications may make it more difficult for a physician or dentist to meet the demanding requirements of his or her work. Individuals may begin to take measures to try and push through and continue to practice.  The most common scenarios we see are practitioners who modify their occupation by limiting the type of procedures they perform (e.g., doing only exams instead of extractions), reducing hours, or taking extended time away from the practice.

Will Reducing My Hours Hurt My Claim?

If you fail to file a timely claim and/or changes to your work schedule have gone on long enough, your ability to collect disability benefits may be jeopardized.  Under most policies, your insurance company will look to what your job duties were immediately prior to filing for disability and you can modify your occupation if you are not careful.  In addition, some policies (typically employer plans) require that insureds work a certain number of hours each week in order to be eligible for benefits.  Under these policies, taking extended breaks may cause an insured to lose coverage.

This highlights the importance of having a transition plan in place, especially if you feel any effects of long-lasting COVID-19 and worry that you will no longer be able to work in your usual fashion for an unknown period of time.  If you have questions about long-term symptoms of COVID-19 and your disability policy, please feel free to contact one of our attorneys directly.

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:

John Hopkins
Mayo Clinic
American Medical Association

 

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Do I Have To See My Doctor In Person During COVID-19?

Most individual disability insurance policies have care provisions, which typically require that a claimant be under the care of a treating provider in order to be eligible for benefits.  The COVID-19 pandemic has made complying with certain care requirements—created in a pre-COVID world—more difficult.

What Are “Care Requirements”?

In addition to other proof of loss requirements, disability policies contain care requirements that state specific conditions that must be met in order to qualify for ongoing disability benefits.  An example provision, taken from an actual policy, is below:

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.

In-Person Requirements and COVID-19

As you can see, the first requirement listed in this care provision is a requirement to not only treat with a doctor, but see the doctor “in person.”  These requirements have been problematic during the course of the COVID-19 pandemic, because many individuals have either had to forego appointments with their doctors, or utilize telehealth appointments, especially at the height of the pandemic.

When the risk of contracting COVID was high and before vaccines were available, it was easier to argue that seeing a doctor in person was too dangerous or impossible (e.g. if the doctor was seeing in-person patients on an emergency-only basis).  However, as things begin to open up more and more, insurance companies will likely begin to push harder to ensure that care requirements are being followed.  At the same time, some providers—such as mental health providers—may not be returning to in-person treatment as quickly as other medical professionals.

Whether or not it is reasonable for an insurer to enforce an in-person care requirement depends on your particular circumstances and the terms of your particular policy.  If you are considering filing a claim, or have filed a claim, and have questions about in-person care requirements, please feel free to contact one of our attorneys directly.

 

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Can I File a Disability Claim for
Breathing Problems Due To COVID-19?

While it may be some time before we fully understand COVID-19 and its long-term impact, experts have identified certain long-term complications from the virus, including breathing problems.

As COVID-19 is a respiratory disorder, it is no surprise that the lungs can be permanently damaged by the virus. Pneumonia associated with the disease can cause long-standing damage to the alveoli (tiny air sacs) in the lungs. Build-up of scar tissue can then lead to long-term breathing problems, including decreased lung function and decreased exercise capacity. Risks of this complication are highest among those with underlying conditions such as lung disease, hypertension, and obesity.[1]

Such disorders can be problematic for occupations that require mask-wearing, such as dentists and surgeons. Healthcare workers, including dentists, are also often most at risk for contracting COVID-19, due on their physical proximity to others and exposure to diseases[2].

In March of 2018, the CDC reported on a cluster of patients (dentists and dental workers) who were treated at a specialty clinic in Virginia for chronic, progressive lung disease, specifically idiopathic pulmonary fibrosis. The CDC said that occupational exposure was a possibility, stating “[d]ental personnel are exposed to infectious agents, chemicals, airborne particulates, ionizing radiation and other potentially hazardous materials. . .[i]nhalational exposures experienced by dentists likely increase their risk for certain work-related respiratory diseases.”[3]

Whether you can file a claim for COVID-19, a resulting complication, or a co-morbid condition depends on the terms of your policy and your unique circumstances. If you have questions about your particular situation, please feel free to contact one of our attorneys directly.

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.

[1] Mayo Clinic.

[2] Lazaro Gamio, The Workers Who Face the Greatest Coronavirus Risk, The New York Times, March 15, 2020.

[3] CDC reports ‘cluster’ of dental professionals diagnosed with lung disease, ADA News, March 13, 2018.

 

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Can I File a Disability Claim
Based on COVID-19?

Since the pandemic started, many physicians and dentists are wondering “can I file a disability claim for COVID-19?”

The answer is–it depends. Disability policies typically have elimination periods that must pass before benefits are payable for a certain condition. Often, the elimination periods are several months and would outlast the typical duration of COVID-19. However, there may be claims where this might not be the case, such as claims involving long-term complications from COVID-19. Or claims involving increased health risks due to underlying conditions.

Can I File for Long-Term Complications?

While we are still in the early stages of knowing how COVID-19 may affect people long-term, initial information indicates both that some individuals will have long-lasting COVID-19 symptoms and some will go on to develop complications as a result of the infection. Studies have shown that some symptoms can linger for weeks and months, including:

    • Fatigue
    • Racing heartbeat
    • Shortness of breath, achy joints
    • Foggy thinking
    • Persistent loss of sense of smell

Others may recover but end up with long-term complications from COVID-19. Experts believe that COVID-19 can result in the following:

    • Heart damage or disease
    • Lung damage or long-lasting breathing problems
    • Brain damage as a result of stroke or seizures, or an increased likelihood of developing Alzheimer’s or Parkinson’s disease
    • Blood clotting that can lead to heart, lung, legs, liver, or kidney problems, or cause hypertension
    • Widespread inflammation
    • Problems with mood and fatigue, including chronic fatigue syndrome

Can I File a Claim for COVID-19 and My Underlying Conditions?

Certain underlying conditions have been associated with more severe COVID-19 symptoms, including:

    • Chronic lung disease, such as COPD
    • Serious heart conditions
    • Obesity
    • Type II diabetes
    • Chronic kidney disease that requires dialysis
    • Conditions that make a patient immunocompromised (including cancer treatment, immune deficiencies, and bone marrow or organ transplant).

Whether you can file a claim for COVID-19, a resulting complication, or a co-morbid condition depends on the terms of your policy and your unique circumstances. If you have questions about your particular situation, please feel free to contact one of our attorneys directly.

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

Centers for Disease Control

University of Maryland

American Association for the Advancement of Science

John Hopkins Medicine

 

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Disability Insurance Claims – COVID-19 Complications

COVID-19 has impacted several aspects of our lives, and many things are much more complicated now. Disability insurance claims are no exception, as COVID-19 has raised additional hurdles for policyholders filing “own occupation” claims. Some of the most common questions and concerns physicians and dentists are facing include:

How long will it take to get a decision during COVID-19?

Typically, insurers can take several months to issue a decision. With many companies operating with limited staff, claim decisions may now take even longer.

Now, more than ever, it is important to be proactive about your claim. Extensive delay may be unreasonable, even during the pandemic. But it is not always easy to determine how long is “too long” to wait.  An experienced disability attorney can help you determine if your disability insurer is unreasonably dragging its feet, or if any action needs to be taken to ensure a timely decision.

What if I can’t get in to see my doctor?

Many policies have care requirements that require you to be actively treating with a physician.  This can be difficult when many doctors’ offices are working on a limited basis. Delays are common, due to the backlog of patients needing to be seen. Certain legal rules allow for delay if it would be unreasonably difficult for you to produce evidence within a required time frame—but these can vary based on your policy and your jurisdiction.

What if I can’t get records or paperwork from my treating providers?

Insurance companies will typically ask for medical records and statements from your treating providers to support your disability.  Because many doctor’s offices are operating at limited capacity, this can also be difficult. Again, depending on your policy and the laws in your jurisdiction, you may be entitled to flexibility when responding to these requests.

Do I have to let my insurance company conduct a field interview or IME?

Insurers often conduct at least one field interview during the course of a claim. Similarly, insurance companies may ask an insured to attend an independent medical examination (IME). Understandably, during this time, insureds are reluctant to be in close proximity with a stranger. An experienced disability attorney can help you determine whether these sorts of requests are reasonable under the circumstances.

The best way to handle these situations depends on the specific terms of your policy and local laws. In some instances, what the insurance company is asking for may be unreasonable, and therefore unenforceable. If you have a question about how COVID-19 has impacted or may impact your claim, please feel free to contact one of our attorneys directly.

 

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Can I File a Claim for Anxiety/Depression/PTSD
Due to COVID-19?

In prior posts, we’ve discussed why physicians and dentists can be uniquely susceptible to burnout and mental health conditions such as anxietypanic disorder, depression, and PTSD. Now, in light of the COVID-19 epidemic, health experts are particularly concerned about physicians working in the intensive care unit, emergency room personnel, paramedics, and other frontline responders.

According to an article in Scientific American, experts believe that health care workers are presently at risk for developing high rates of anxiety, depression, substance use issues, acute stress and, eventually PTSD as a result of working on the front lines during the pandemic.

For example, one study of physicians and nurses in China at the height of the pandemic found that 50% of respondents reported symptoms of depression, 44% reported anxiety, and 34% reported insomnia.[1] Another study of data from the United Kingdom and U.S. showed that frontline health care workers had a nearly 12 times higher risk of testing positive for COVID-19 compared with those in the general community.  This rate was even higher for workers that didn’t have adequate access to PPE.[2]

Stress and emotional turmoil can also be related to caring for those most gravely ill with the disease, especially in light of the fact that many of these patients are dying without access to friends or family members. In situations where physicians normally would have turned to their families and friends for support, they are now fearful of passing the virus along to their loved ones, and many physicians are choosing to even live apart from their families and/or distance themselves from friends and colleagues outside of the hospital setting.

While the coronavirus and hospitalizations are abating in some parts of the country, frontline workers are also now facing new challenges.  In a New York Times article, Dr. Mark Rosenberg, the chairman of the emergency department at St. Joseph’s Health in Paterson, New Jersey, was quoted as saying “[a]s the pandemic intensity seems to fade, so does the adrenaline. What’s left are the emotions of dealing with the trauma and stress of the many patients we cared for.”[3]

For some, mental health conditions stemming from or exacerbated by COVID-19 can become persistent and long-lasting conditions.  If you have reached this point, you may be wondering if filing a disability insurance claim is an option for you.  If you have questions about whether you can file a claim under your disability policy, please feel free to contact one of our attorneys directly.

[1] Jillian Mock, Psychological Trauma Is the Next Crisis for Coronavirus Health Workers, Scientific American, June 1, 2020, https://www.scientificamerican.com/article/psychological-trauma-is-the-next-crisis-for-coronavirus-health-workers1/

[2] Katie Marquedant, Study Reveals the Risk of COVID-19 Infection Among Health Care Workers, Massachusetts General Hospital Press Release, May 5, 2020, https://www.massgeneral.org/news/coronavirus/study-reveals-risk-of-covid-19-infection-among-health-care-workers

[3] Jan Hoffman, ‘I can’t Turn My Brain Off’: PTSD and Burnout Threaten Medical Workers, The New York Times, May 16, 2020, https://www.nytimes.com/2020/05/16/health/coronavirus-ptsd-medical-workers.html

 

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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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