Davies/DMS Disability Claim Tips for Physicians
Disability Management Services (DMS), which has now been re-branded as Davies Life & Health (Davies), is a third-party administrator that handles claims and benefits for several disability insurance companies.
In our experience, Davies/DMS is one of the most aggressive, bottom-line oriented administrators of physician disability claims. As discussed below, Davies/DMS devotes a substantial amount of resources looking for “creative” ways to reduce or limit liability for its disability insurance company clients.
If you are a physician with a disability claim being handled by Davies Life & Health/Disability Management Services, it is essential that you have an experienced disability insurance attorney represent you as soon as possible to ensure you are treated fairly and do not unknowingly prejudice your rights.
Our attorneys understand how Davies/DMS operates and what it takes to file a successful disability claim with Davies. If you would like to hear what other physicians have to say about us and see why our law firm is the best option for physicians with disability claims, please visit our testimonials page.
Below are some answers to the most common questions our attorneys receive from physicians about the disability claim process and Davies/DMS, specifically. If you’d like to discuss your particular claim with our attorneys, we are happy to set up a free consultation.
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1. Are Disability Management Services (DMS) and Davies Life & Health (Davies) the same company? Why did Disability Management Services change its name?
In 2021, Davies Group, Ltd. acquired Disability Management Services (DMS), a company that was created to take over claim management, among other things, for disability insurance companies. DMS touted its ability to save insurance companies money and had a reputation in the industry (and among disability insurance attorneys) for being adversarial.
Since the acquisition, Davies Group has been actively seeking to “re-brand” DMS, now calling it “Davies Life & Health, Inc.” Despite the new name, many of the key personnel remain the same and Davies/DMS’s role as a bottom-line driven claim administrator—discussed in detail below—remains the same.
2. My disability insurance policy is not with Davies/DMS. Why is Davies/DMS administering my disability claim? What is a third-party administrator?
Davies/DMS is not an insurance company; it is a third-party administrator that provides claims, administration, consulting and auditing services to disability insurance companies. If Davies/DMS is administering your claim, all correspondence, forms, decisions and appeals will generally be handled through them, not your original insurance company.
Smaller disability companies, disability companies that no longer actively offer disability insurance policies, or disability companies that don’t want to hire and pay claim administration personnel often hire third-part administrators to handle claims and keeps costs down.
This creates bad incentives, as third-party administrators seek to secure more contracts with insurance companies by limiting benefit payments wherever possible. As a result, in our experience, third-party administrators tend to be more adversarial when investigating and vetting claims (particularly physician claims that represent significant financial exposure for their insurance company clients).
Some companies that have used or continue to use Davies/DMS as a third-party administrator include Penn Mutual, Lloyd’s of London, AXA Equitable Life Insurance Company, Massachusetts Casualty Insurance Company, Equitable Life Assurance Society of the United States, Ohio National, and Mony Life Insurance Company/the Mutual Life Insurance Company of New York, to name just a few.
3. I heard that my insurance company no longer sells disability policies to physicians. Is this why Davies/DMS is involved? Will Davies/DMS deny my disability claim?
Davies/DMS markets itself as providing “Legacy Block Management” for disability insurance companies. This refers to situations where disability insurers are no longer selling insurance to new customers (i.e. a “closed-block” of business) but continue to collect premiums and have claims filed by existing policyholders.
These closed-block or “legacy” claims are typically handled more aggressively and receive higher scrutiny for a few reasons. First, the Davies/DMS client (the insurer) only receives ongoing profits from the block of business if the premiums coming in are greater than the benefits being paid out to claimants. Additionally, because the underlying insurer is no longer selling policies (and may have merged with a different company or changed names) the reputation of the insurer and its accountability to the states’ departments of insurance may no longer be a priority.
4. I heard from other physicians that Davies/DMS is a difficult company to deal with. Is this true?
Yes, in our experience Davies/DMS can be difficult to deal with.
As explained above, as a third-party administrator, Davies/DMS works for the insurance company and does not have any financial incentive to pay claims. This is apparent if you visit www.disabilitymanagementservices.com, which, as of April 2023, continues to exist post-acquisition.
For example, Davies/DMS “Claim Management” page, states in a call-out that:
“Disability benefit eligibility determinations are seldom black and white. Moreover, disability is rarely static in nature. People recover and return to work. Or, they remain disabled and adapt. Sometimes their conditions worsen.” (Emphasis added.)
In our experience, most physicians who are making the difficult decision to give up their practices and careers have permanent, long-term disabilities. They do not “recover,” they cannot “adapt” professionally. Most often, they have musculoskeletal conditions that do, in fact, worsen over time and are aggravated/accelerated by practicing medicine. However, this group is notably trivialized in the above tag-lines.
Reading further on the same page, Davies/DMS stresses the importance of its focus on “early and proactive involvement with every disability claim.” It continues and states that its claim professionals “often interact with treating medical providers, specialized clinical experts, medical consultants, vocational specialists, forensic accountants, investigation professionals and legal advisers.” Davies/DMS touts its “national network of Independent Medical Examination providers, Peer Review experts, and Functional Capacity Evaluation professionals.” Davies/DMS then concludes by assuring that all “active claims” will be “appropriately managed” for “the duration of the disability.”
Our experience with Davies/DMS aligns with the above. As discussed in more detail below, Davies/DMS utilizes a large team of specialists to pour over all aspects of a claim, often in an attempt to find any reason to deny or terminate benefits.
5. I am a physician with an “own occupation” private disability policy. Will that make it more difficult for Davies/DMS to deny my claim?
Unfortunately, in our experience, physician claims under private disability policies (i.e. IDI claims) receive a high degree of scrutiny from Davies/DMS. Although the policy terms can be more favorable than policies that are not “own occupation,” these policies represent the highest liabilities for Davies/DMS’s insurer clients. As such, Davies/DMS devotes its most experienced analysts and substantial resources to that block of business.
As of April 2023, the Davies/DMS website states that it specifically staffs IDI claims with “well trained, experienced and highly skilled claim professionals”—i.e. the most senior analysts. It also stresses the importance of “early and direct involvement” and “comprehensive benefit eligibility assessment”—i.e. IDI claims are subjected to the highest scrutiny. It even goes so far as to mention its “activity-based claim objectification” strategy for dealing with IDI claims.
As you can see, if your claim is being handled by Davies/DMS, you can expect an in-depth review by experienced claim personnel, with a high emphasis on your activity levels. This includes questioning your hobbies, interests, and activity levels in day-to-day life, even if you are not working in your occupation.
In our experience, Davies/DMS approaches physicians’ claims with a high level of skepticism, and can infer capacity to work from activities that have nothing to do with the physician’s underlying occupation/specialty. Davies/DMS devotes significant resources to physician claims and, at a minimum, will conduct online surveillance and will not hesitate to conduct in-person surveillance if it believes it is warranted.
Davies/DMS also emphasizes early intervention and seeks to gather the answers to complex questions at the outset. They know that most physicians do not know much about the claims process or how their policies work, and they know that the easiest time to sow confusion on a claim and create a favorable record, is early-on, before a disability attorney is involved.
6. Why is it taking so long for Davies/DMS to make a claims decision? Why does Davies/DMS keep coming back with more questions, and how are they coming up with all of these questions?
As noted above, Davies/DMS devotes a significant amount of time and resources to physician IDI claims. Much of this takes place behind the scenes, without your knowledge. However, if you visit Davies/DMS’s website, where it describes its services to its prospective insurance company clients, you can get a better sense of what you are up against.
As of April 2023, the page describing how Davies/DMS handles IDI claims shows this visually with a diagram of its “claim consultant” surrounded by a vast array of resources, including:
- Claim Director
- Vocational/Occupational Specialists
- Financial Resources
- Investigative Resources
- Actuarial Resources
- Claim Counsel (i.e. attorneys)
- IME and FCE Resources
- Psychiatric Resources
- Medical Resources
Another page lists the following “Internal Resources” and “Vendor Resources”:
Davies/DMS “Internal Resources”
- Disability Claim Specialists
- Appeals Specialists
- Social Workers
- Masters Level Therapists
- Clinical and Forensic Psychologists
- Database Researchers
- Vocational Rehabilitation Professionals
- Financial Specialists
Davies/DMS “Vendor Resources”
- Medical Evaluation
- Specialized Vocational Resources
- Social Security Advocacy
- External Legal
As you can see, Davies/DMS already has experts on its payroll, or that it has worked with before, for any topic that may come up on physician claims. These experts operate behind the scenes to look for and exploit any weaknesses/holes in your disability claim from a factual, legal, occupational, or medical perspective. If you don’t proactively prove-up your claim from the start, this can place you at a significant disadvantage if your claim has been targeted for denial or termination.
This does not mean that it is impossible to collect if your claim is administered by Davies/DMS. But it does mean that it is advisable to approach the claim with a comparable degree of seriousness, and the counsel of an experienced disability attorney who has significant experience in the industry and with Davies/DMS.
7. What should physicians watch out for if their disability claims are being handled by Davies/DMS?
As noted above, Davies/DMS analysts assigned to physician claims are typically senior, highly experienced analysts. They have the capacity and resources to come up with claim-specific challenges to payment, and have the incentive to do so. However, there are a few common themes that we have seen with Davies/DMS:
Challenging the Selected Date of Disability. Davies/DMS will not hesitant to challenge your selected date of disability if it is unfavorable to its insurer clients. For example, if you need to be disabled before a certain day to qualify for lifetime benefits, Davies/DMS may look for any way to push your disability onset to a later date, to avoid lifetime benefits. Or Davies/DMS might seek to reduce payment of back-benefits by claiming that you did not have sufficient medical treatment during earlier timeframes, even if your medical condition is clear and supported by your doctors.
Mischaracterizing the Underlying Occupation. Davies/DMS also has vocational experts that resolve any ambiguities in reported duties and CDT codes against the policyholder. We have been involved in matters where Davies/DMS has attempted to take advantage of limited occupational information in its file to ignore physicians’ specialties and/or the nuances of their particular practices. Instead of getting to the bottom of the most challenging aspects of the occupation, Davies/DMS is happy to assume that you had no particularly difficult duties, and that your practice was as limited as possible, absent detailed proof to the contrary. If you have a cash-practice, or work in another setting—such as a government hospital—where there are not comprehensive CDT codes, Davies/DMS may seek to take advantage of the lack of codes to question your occupational duties and the extent of your limitations.
Mischaracterizing a Total Disability Claim as a Residual/Partial Disability Claim. The above tactics—surveillance, misinterpreting your occupation, etc.—are also often commonly used by Davies/DMS to mischaracterize a claim as a residual/partial disability claim instead of a total disability claim. Davies/DMS may suggest that you can still work (even if it is not safe to do so), state that you will only be receiving partial benefits, and then pressure you to return to work.
Ignoring/Trivializing the Opinions of Treatment Doctors. Davies/DMS may discount the opinions of treating doctors who are supportive of the disability claim, while giving too much weight to biased medical reviewers who have never interviewed or examined the claimant in-person. In our experience, Davies/DMS also utilizes medical reviewers who comb the records for statements that, in their view, undercut disability, while ignoring statements that corroborate the claim for disability.
8. Why is Davies/DMS asking to see my CDT codes?
Davies/DMS will typically gather CDT codes to confirm you were a practicing physician, determine what your substantial and material duties are/were, and whether you have changed them over time (either by reducing your production generally or avoiding certain types of dental procedures).
If they see a change in the types of duties you have been doing leading up to filing a disability claim, Davies/DMS may argue that you have modified your occupation, that your material and substantial duties are different than what they actually are, and that you can still work in a part-time capacity. Davies/DMS will often preface this argument by characterizing your practice as a “light duty” occupation that you can do even with some degree of physical limitation.
9. Why is Davies/DMS trying to push me to “return to work” when it is not safe for my patients/my own health?
As noted above, Davies/DMS’s website outlines its approach in IDI claims on its website. As of April 2023, it expressly listed “[e]arly and direct vocational intervention with return-to-work focus” as one of its “Keys to Success” in IDI claims (emphasis added).
Sometimes a return to work is appropriate, but it is not something that should be rushed given patient safety and malpractice liability concerns. If you ultimately decide you can return to work, it should be on your timetable—not because Davies/DMS wants to end your claim.
If you feel that Davies/DMS is pushing you back to work prematurely, it is advisable to have an attorney involved if you do not already have one.
10. Do I need to hire a Davies/DMS disability attorney to file my claim?
While there are certainly claims that may not require attorney involvement—for example, a disability claim due to the loss of a limb or something very serious, such as paralysis—in our experience physician claims are not that straightforward.
Many of our clients have more nuanced conditions, such as slowly progressive musculoskeletal conditions due to degenerative disc disease. Others have conditions like a tremor, that may not prevent them from working in other jobs, but have a significant impact on their ability to work as a physician. Others have mental health conditions (anxiety disorder, panic attacks, PTSD) that cannot be verified by a single, definitive objective test.
Obviously, if your claim is denied or you have a dispute over policy interpretation, you may need an attorney to become involved to resolve the matter. That being said, lawsuits with insurance companies/third-party administrators are often costly, stressful, and, in some instances, can drag out over several years, all to the insurance company’s advantage. Even if you prevail, it can be an exhausting process, and companies typically appeal, which can take at least another year or more, all the while you are not getting paid benefits.
In our view, it is more prudent to approach your claim carefully from the outset and have your attorney address any concerns that Davies/DMS may have over the course of the investigation itself, so that you are not placed in a position where benefits have been cut off, you are not working and your only option is a lawsuit. This is particularly important when dealing with a third-party administrator like Davies/DMS.
In our experience, the most common areas where complexities can arise in physician’s disability claims include:
- The timing of the claim (particularly in situations where a disabling condition is slowly progressive or the where the physician works too long in spite of his/her condition);
- Claims made by physicians with multiple sources of income, some of which may continue post-disability;
- Claims made by physicians who have taken an active role in office/hospital administration or are involved in non-clinical work;
- Claims where a physician was terminated or left a prior employer on bad-terms, making it more difficult to obtain third-party confirmation of the physician’s occupation, role and job duties;
- Claims involving multiple policies with different insurers;
- Claims initially handled by the physician individually, without legal representation;
- Claims where the physician has already submitted to an interview under oath or an insurance company medical exam;
- Claims involving an inadequate medical work-up and/or limited treatment history;
- Claims involving high benefit amounts, young claimants and potentially permanent conditions;
- Claims involving conflicting recommendations for or against worksite modifications, certain treatments, procedures and/or surgery;
- Claims where the underlying condition is difficult to diagnose or is diagnosed by exclusion;
- Claims involving musculoskeletal conditions; and
- Claims involving mental health conditions.
11. When should I contact an attorney about my Davies/DMS disability claim?
Physicians who are considering filing a claim for disability insurance benefits should meet with a disability attorney well-before submitting a claim.
Each disability policy has different, complex language that insurance companies may manipulate to circumscribe and restrict coverage. Before filing, physicians should make a coordinated effort, with an attorney’s assistance, to determine whether their particular claim is covered, and if so, how that claim is best presented to ensure payment.
If you did not meet with an attorney prior to filing, and learn that Davies/DMS is administering your claim, you should speak with an experienced disability attorney as soon as possible.
The information provided above is offered purely for informational purposes. It is not intended to create or promote an attorney-client relationship, and does not constitute and should not be relied upon as legal advice.
Every claim is unique and the discussion above is only a limited summary of information that may be relevant to your claim. If you are concerned that Davies/DMS is not handling your claim fairly, an experienced disability insurance attorney can help you assess the situation and determine what options are available to you.
Notable Disability Insurance Cases Involving Davies/DMS
Mony Life Ins. Co. v. Perez, No. 8:19-CV-2031-WFJ-TGW (M.D. Fla. June 21, 2022) (insurer wrongfully asserted that ERISA applied to policy, terminated benefits of an eye surgeon, who was a cancer survivor, and sought to claw-back benefits because the surgeon would not submit to a forensic financial audit that was not expressly authorized by the policy).
Lott v. AXA Equitable Life Ins. Co., No. 118CV00063GHDDAS (N.D. Miss. Oct. 15, 2019) (insurer/DMS terminated benefits of claimant with multiple sclerosis after nearly 7 years of paying benefits).
Oliver v. MONY Life Ins. Co., No. 2:15-CV-00905-AKK (N.D. Ala. Dec. 21, 2016) (insurer/DMS denied claim, asserting that claimant had no “occupation” because the underlying injury occurred when claimant was not employed and asserting that claimant must prove that he cannot do his “substantial and material daily activities” just prior to the date of injury, to collect disability benefits under the policy).
Smith v. Mony Life Ins. Co., No. 1:12-CV-291-ODE (N.D. Ga. Nov. 7, 2012) (insurer/DMS terminated school teacher’s disability benefits and asserted that subsequent lawsuit was not timely filed under the applicable statute of limitations).