Who We Represent

For nearly three decades, Ed Comitz has developed a nationally recognized disability insurance practice located in Phoenix, Arizona, and has a record of successfully representing clients throughout the country. Ed exclusively represents professionals – primarily physicians, dentists, other attorneys and business executives – filing disability claims under “own occupation” and “specialty-specific” disability insurance policies.

Many of Ed’s clients come to him because they have the types of nuanced claims that insurers typically challenge, such as:

• Mental-health conditions (e.g. depression, anxiety, panic disorder, PTSD),
• Conditions with symptoms that are largely subjectively reported (e.g. musculoskeletal conditions, carpal tunnel syndrome/ulnar neuropathy, Rheumatoid Arthritis, pain-related syndromes, tinnitus, vestibular migraine, POTS),
• Conditions where the severity of symptoms and progression vary from patient to patient (e.g. cervical and lumbar degenerative disc disease, herniated discs, spondylosis, spinal stenosis, neurological disorders), or
• Conditions that are largely diagnosed by exclusion, through differential diagnoses (e.g. POTS, stroke, Crohn’s disease, cognitive disorders).

Some have conditions that are exacerbated by their workplace environment, but they are able to manage their symptoms if, for example, they no longer have to practice dentistry or hold static positions for hours as an orthopedic surgeon.

Others involve very discrete issues, like an essential tremor, neuropathy, the partial amputation of a finger, or a neuroma, that significantly impact the clients’ ability to safely practice their “own occupation” but do not prevent them from performing the activities of daily living, certain recreational activities or other jobs.

Own-Occupation Disability Insurance Claims

Disability insurers have also changed own-occupation policies over time to make it harder to collect benefits.

They proceeded to revamp their policies and give themselves more investigative tools and extremely broad discretion, while adding additional exclusion and limitation provisions and crafting pitfalls designed to target professionals and catch them unaware.

Policies that used to be only a few pages long transformed into 50 to 60 page documents as the companies added language intended to make it much harder to collect, such as:

• Providing various levels of purported “own occupation” insurance, even though the policies do not actually provide true own occupation coverage and are simply meant to look as if they do;
• Complex and compound policy applications combined with provisions that allow them to void coverage for any misrepresentations in the original application, even if they were innocent or irrelevant to your actual sickness/injury;
• Requirements that you submit to interviews under oath;
• Requirements that you be medically examined by the insurer’s doctors, or undergo neurophysiological testing, with an examiner of the insurer’s choosing at any time in the insurer’s discretion;
• Requirements that you must seek all necessary treatment until you reach “maximum medical improvement,” including having your physician create a “written” treatment plan that must be approved by the company and is designed with the purpose of “returning you to work”;
• Provisions requiring you to demonstrate that there are no “work-site modifications” that would allow you to work;
• Provisions that allow your insurer, their in-house doctors and outside experts to speak directly with your doctors outside of your presence;
• Requirements that you produce your taxes, profit and loss statements, billing codes, and other financial information for audit whenever they deem necessary; and
• Provisions requiring you to produce “objective evidence” of your claim and/or placing limitations on, or excluding, mental health conditions and/or conditions that have subjective symptoms.

The end result is that professionals filing a disability claim face a war on two fronts. They must be wary of avoiding policy traps and technical violations of their policy that might give their insurer a basis to terminate or reduce their benefits, as well as financially-motivated bad faith tactics that insurance companies use to wrongfully deny claims.

Disability Insurance Claim Denial Tactics

Unlike other types of insurance, disability claims are subject to ongoing evaluation and scrutiny. Given the potential duration of claims and amount of money at stake, professional disability insurance companies are often investigated and sanctioned by regulators for engaging in systemic unfair claims practices, including improperly targeting and terminating high-dollar claims. For example:

• Unum Corporation – Multistate Market Conduct Examination:  Finding that Unum (including Paul Revere, Provident and other affiliates) excessively relied upon biased in-house medical professionals, ignored the opinions of treating doctors, and misinterpreted medical records.
• Guardian/Berkshire – Massachusetts Market Conduct Examination:  Finding that Guardian had failed to timely process claims, failed to properly document claim files, and miscalculated benefits.
• Guardian/Berkshire – Maryland Insurance Administration’s Order:  Finding that Berkshire’s claim forms were misleading and that the company gave “the appearance of investigating a claim in order to render a good faith claims determination. . . . however, Berkshire [did] not analyze the information at all, much less use an analysis in a cogent and rational way to support a proper claims determination.”
• MetLife – California Market Conduct Examination: Finding that Met Life denied claims without requesting important medical records, repeatedly requested information that had already been provided, improperly estimated return to work dates, and misrepresented policy provisions.

In today’s uncertain economic climate, with fewer professionals buying disability insurance, many disability insurance companies are merging, facing pressure to reduce reserves or going out of business altogether. Unfortunately, this creates incentives to reduce losses by denying or terminating legitimate claims.

Insurers unfortunately continue to lob a seemingly endless barrage of obstacles at claimants, including: (1) video surveillance; (2) unannounced interviews; (3) in-house medical evaluations; (4) defense medical exams; (5) financial and insurance audits; (6) re-evaluation of answers on application forms; and (7) investigations of prior litigation and board complaints, as well as a wide variety of other tactics, some of which are discussed above, all aimed at increasing their bottom line.

Experience Representing Policyholders

The lists below provide an overview of the professionals we represent, the disability insurance companies we file claims with and litigate against, and a non-exhaustive list of some of the disabling conditions our prior clients have had.