Insurance Company Tactics:

We’ve discussed before how insurers often use surveillance in disability claimsPhysicians’ claims and dentists’ claims, in particular, are often targeted due to the high benefit amounts the company can save by denying or terminating the claim. Accordingly, professionals filing claims should expect that they’ll be under surveillance at least once, and sometimes several times, throughout the course of their claim.

If the company is able to obtain surveillance footage, the company may overstate the significance of the footage in an effort to deny or terminate benefits. The case of Fleming v. Unum[1] illustrates how insurers use surveillance as a tactic to improperly terminate benefits. Pamela Fleming worked a litigation attorney until she was in a serious car accident and suffered severe injuries to her neck and thoracic spine, leaving her unable to work. Fleming had own occupation policies that defined “disability” as the inability to do the material and substantial duties of her occupation.

After having paid her claim for over a decade, Unum hired a surveillance company to videotape Fleming. The surveillance video showed Fleming throwing away a bag of garbage, putting a cooler in her car, and then driving a significant distance. Unum told Fleming that the footage conflicted with her previously reported limitations and terminated her benefits.

When her claim was denied, Fleming sued Unum and the court ultimately reversed the claim denial. In doing so, the court determined that Unum had greatly overemphasized the significance of the surveillance footage. The court noted that while the video showed Fleming lifting a garbage bag, “[l]ifting the bag over her head was no feat of strength or indication of recovery” because it was clear from the surveillance footage itself that “the bag of trash contain[ed] empty plastic bottles.” The court then concluded that “[t]he fact that Fleming took out the trash or bent down to place a one-pound cooler in her car does not render her capable of full-time employment as a litigation attorney.”

Similarly, the court criticized Unum for taking the footage out of context, observing that the footage “shows Fleming leaving her apartment once—for a doctor’s appointment—over the course of two days.” The Court then noted that “[b]oth coming and going from her apartment, Fleming walked gingerly  down and up a flight of stairs, one step at a time, while holding onto the handrail for support” and concluded, “[i]f anything, the surveillance footage confirms that Fleming spent the majority of her time at home and had to utilize extreme care when leaving her apartment . . . . The Court sees no reason to credit Unum’s 15 minutes of surveillance footage from one day here, especially when it is contradicted by over ten years of medical records” (emphasis added).

Luckily for Fleming, the judge in her case saw through Unums attempt to improperly terminate her claim. But, unfortunately, judges and juries can all too often put undue weight on surveillance footage, because it is easy to present out of context and is more interesting and attention-grabbing than other relevant evidence, such as medical records and doctors’ opinions. Consequently, it is likely that companies will continue to take this sort of footage out of context, in the hopes that claimants will give up and not challenge the denial, or give in and accept a low-ball settlement once their benefits are cut off.

Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you feel that your insurer is improperly using surveillance, an experienced disability insurance attorney can help you assess your particular situation and determine whether the insurer’s action is appropriate.

[1] Fleming v. Unum, 2018 WL 6133859 (2018).


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Why Was My Claim Denied?
What Do I Do Now?

A disability insurance claim can be denied for a variety of reasons. Some reasons are legitimate, and some are not. This can be especially true for dentist and physician claims that can be targeted for denial simply because of the policies’ high benefit amounts and how much money is at stake.

Knowing the specific reason or reasons for a disability insurance claim denial is critical to deciding what your next step should be. Because of this, some states, including Arizona, have adopted laws that require insurers to provide you with timely information explaining the basis for a denial. In both Arizona and California, an insurer that denies a claim must provide a reasonable explanation for the denial based on the terms of the policy, the facts, or the applicable law.[1]  Some states’ laws also require that the notice of denial must be in writing, must reference any specific grounds for denial, and must explain how those grounds specifically apply to your claim.[2]  Failure to provide an explanation could lead to a finding that your insurer acted in bad faith.

When you receive the explanation of denial, chances are it may be confusing to understand. Even if an explanation is provided, it may still warrant a finding of bad faith if the explanation fails to clearly communicate the rationale behind a denial[3] , or the denial was founded on an improper bases (e.g. a biased medical exam).

If you have already filed and your insurance company has wholly or partially denied your claim, there is often a short window of time in which to act if you wish to preserve your claim. If you have filed a claim, or you are facing a denial from your insurance company, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.

[1] A.R.S. § 20-461(A)(15) (2018); Cal. Ins. Code § 790.03(h)(13) (2018).

[2] Cal. Code Regs. tit. 10, § 2695.7 (2018).

[3] See, e.g., the California case of du Mortier v. Mass. General Life Ins. Co., 805 F.Supp. 816, 823 (C.D. Cal. 1992).


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Disability Insurance Basics:
Business Overhead Expense Policies

We have previously discussed how important it is to periodically review your disability insurance policies to make sure your coverage and benefit amounts reflect where you are at in your career. Most physicians and dentists purchase a disability policy at the beginning of their careers. However, as time goes on, their financial situation, family life, and practice can evolve into something completely different that requires a different level of coverage.

A “business overhead expense policy” is one type of policy that many doctors consider when they have reached the point in their career where they are purchasing their own practice. These policies are designed for practice owners and cover short term business-related expenses. If you become disabled, these policies can help you cover day-to-day operations for a certain period of time (typically 1-2 years) to give you time to heal and return to practicing (or, alternatively, give you time to sell the practice, if you have a condition that is more permanent in nature and are having difficulty finding a buyer).

Like any disability insurance policy, each BOE policy is unique. Some common covered expenses can include:

  • Rent
  • Real estate and property taxes
  • Utilities
  • Laundry, janitorial, maintenance services
  • Licensing fees and dues
  • Insurance premiums
  • Billing and collection fees
  • Taxes
  • Interest on debts
  • Depreciation or scheduled installment payments on principal of debt
  • Rent or lease expenses on items such as furniture, equipment, other assets used in the practice
  • Normal, necessary, and customary fixed expenses
  • Salary(ies) of substitute employee(s) – this can be especially attractive to sole practitioners, who may need to employ another dentist or physician to keep their practices in operation

Keep in mind that a business overhead expense policy will typically not cover your lost wages, and typically only last for a limited time, so you will need to have other policies to protect your own monthly income in the event of a long-term disability. Some business overhead policies also contain a list of costs that are not covered by the policy, such as:

  • The cost of goods or merchandise
  • Implements of your profession
  • Premiums waived due to disability
  • Income or self-employment taxes
  • Purchases (such as equipment) after the date of disability
  • Prepayment or advance payment of covered overhead expenses
  • Salaries for employees that are also family members

Consequently, it is important to read your policy carefully so that you have a clear understanding of the expenses that are covered and the expenses that are not.

These are just a few examples of things to be aware of if you have or are considering a Business Overhead Expense policy. These policies are not all identical, and they are updated frequently. Your policy may or may not include the provisions mentioned above. If you are considering filing a disability claim, you should consult with an experienced disability insurance attorney to learn more about your policy and any potential issues related to your particular claim.


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Why Does the Insurance Company
Want My CDT/CPT Codes?

When filing a claim, many dentists and doctors think that they will merely have to submit a form giving notice of the claim and have their doctor sign something verifying they are disabled. Most don’t realize or expect the breadth of their insurance company’s investigation and one thing that often surprises dentists and physicians is the company’s request for their CPT or CDT codes. Most newer insurance policies contain language that expressly allows insurers to request financial and practice information like this, and there are several things they are looking at when they request these codes.

Changes to Your Occupation/Job Duties

Most own occupation policies say they will consider you to be totally disabled if you can no longer do the “material and substantial” duties of your occupation. Insurance companies will look to CDT/CPT codes to see if you have changed or limited the types of procedures you do, and thus potentially modified your job description, prior to filing the disability.

When you file a claim, the company will typically be looking at what your duties were immediately prior to your reported date of disability. If you stopped performing more difficult procedures for an extended period prior to your date of disability, many companies will try to narrowly define your occupational duties as something less than what you perceive your occupation to be. For example, they might characterize you as a “dentist who doesn’t do root canals,” or a “surgeon who doesn’t do hip surgeries.”

Changes in Hours/Production

Similarly, reducing your work hours prior to filing a claim can impact your ability to collect. While your CDT/CPT codes won’t necessarily directly show the hours and days worked, they will show drops/increases in production and prompt follow-up questions from the insurance company if the production numbers don’t add up.

Additionally, some policies require an insured to work a certain number of hours a week, and cutting back on hours for an extended period of time prior to filing a claim could also lead your insurance company to classify your occupation as “part-time.” This is problematic because it becomes much harder to prove you can’t work part-time, versus proving you can’t work full-time.

Reviewing and understanding your policy, including what types of information your insurance company will request, is an important part of any transition plan. If you are considering filing a disability claim, you should consult with an experienced disability insurance attorney to learn more about your policy and any potential issues related to your particular claim.


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Unum Study Shows the Prevalence of
Mental Illness in the Workplace

In prior posts, we’ve discussed the mental health challenges physicians and dentists can face due to their high-stress and high-responsibility work environments. We often see doctors who are wondering if they can successfully file a claim based on a mental health condition, but are also reluctant to ask because they are concerned about what their colleagues/families/friends with think. Often, they feel like they are the only one struggling with these challenges but, in reality, they are not alone.

Unum, one of the largest disability insurers in the U.S., recently released a report[1] that looks at mental health challenges in the U.S. workplace. The report found that mental illness was one of the top causes of worker disability in the United States, with 62 percent of missed work days attributable to mental health conditions. Of those employees with mental health conditions:

  • Forty-six percent of those who missed work took an extended period of time off (over a week)
  • Two-thirds of employees with mental health issues went to work while experiencing symptoms (and reported a drop in productivity)
  • Forty-two percent of those who came to work were experiencing suicidal feelings

Despite the prevalence of mental health conditions (including anxiety, depression, and PTSD), sixty-one percent of the surveyed employees indicated that they felt there was a social stigma around those with mental health issues.

Although this study looked at data from employees, human resource professionals, mental health professionals, and research organizations that was not specific to the medical field, it is widely accepted that doctors are among those most likely to experience burnout during the course of their careers, with symptoms that overlap those of depression, anxiety disorder(s), and/or other mental health conditions. Unfortunately, stigma in the workplace and presenteeism may make doctors even more likely to ignore the symptoms of a mental health condition, push themselves to keep working, and/or avoid seeking support on the job and/or through treatment.

Ironically, we often see Unum (and other insurance companies) target mental health claims made by professionals due to the higher benefit amount of their policies and the more subjective nature of symptoms related to mental health conditions. They may pressure your treating provider for a return to work date, conduct surveillance to catch you in a happy moment that can be taken out of context, or have their in-house doctor question your course of treatment.

Further, many disability insurance policies now have substance abuse and mental health limitations provisions, which limit the amount of time a policyholder can collect for these types of conditions (usually to 24 months).  For these reasons, it is very important for physicians, dentists, and other professionals to have an awarenes of the challenges that may arise when filing a claim and understand what their policy says.

If you are considering filing a disability claim based on a mental health condition, you should consult with an experienced disability insurance attorney to learn more about your policy and any potential issues related to your particular claim.

[1] Unum report explores mental health challenges in U.S. workplaces, Unum, March 27, 2019.


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Arizona Now Matches
Other States’ Professional Licenses

In April 2019, Arizona Governor Doug Ducey signed legislation making Arizona the first state to match other states’ professional licenses. This allows individuals whose jobs require licenses, including dentists and physicians, to automatically receive a license in Arizona, provided they held a similar license in another state for at least one year with no disciplinary action. Under the new law, Arizona’s licensing boards can only test for Arizona-specific information.

Proponents say it paves the way for skilled workers to relocate and bring their expertise to Arizona, without added expense and time delays before they can start working. Further, those in support say it could help to address the medical and nursing shortages in Arizona. Those against the bill cited potential public health and safety concerns, arguing that some states have easier licensing requirements and that new arrivals will compete with those currently practicing in Arizona, potentially driving down wages.

Other states have taken less sweeping steps to ease licensing requirements for relocating professionals, such as reciprocity agreements between states and, in the case of Utah, accepting licenses from other states, but only for military spouses.

Currently, the American Medical Association advises physicians, in general, to plan to wait 60 days between the date an application is submitted and the date a license to practice medicine is granted. The American Dental Association, while supporting individual state’s rights to regulate licensure for dentists, has also adopted policies on licensure issues, including the freedom of movement for dentists and standardization of clinical licensing examinations.

At the bill’s signing in Phoenix, the governor said an expected 100,000 relocating professionals will benefit from the legislation in 2019. Attorneys, private investigators, and security guards are exempt from the new legislation and are still required to complete the Arizona licensing process. As of this writing, the law is expected to go into effect August 2, 2019.



Jonathan J. Cooper, Arizona becomes 1st to match out-of-state work licenses, Associated Press, April 10, 2019.

Lurissa Carbajal, Arizona becomes the first state to recognize all out-of-state occupational licenses, Cronkite News, April 10, 2019.

Howard Fischer, Ducey signs bill for state to recognize out-of-state-license, Arizona Capitol Times, April 10, 2019.

American Medical Association, Obtaining a medical license

American Dental Association, Licensure Overview


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Can You Collect On Your Specialty Specific Policy?
A Case Study

Disability claims filed by professionals can be complex, particularly when the dentist or physician’s underlying occupation is a specialty specific field.

If the claim involves a discrete practice area, disability insurers may use that as an excuse to drag their feet when making a claims decision. For example, they may make repeated requests for employer questionnaires, financial information and/or vocational examinations, among other things. Then, as time goes on, the financial pressures of being left with no income build, prompting some doctors to consider a return to work even though it’s not safe for them to be practicing on patients. Other doctors with specialty-specific policies reason that they can return to work in a different field and expect to receive their benefits as a supplement to the new job, only to find that their insurer disagrees that they were, in fact, a specialist, and refuses to pay total disability benefits.

This is what happened to Joanne Ceimo, M.D., a former invasive cardiologist from Scottsdale, Arizona who practiced at Banner Boswell Medical Center in Sun City, Arizona.[1] Dr. Ceimo had an own occupation policy and was practicing within her medically recognized specialty of invasive cardiology. In 1994, doctors diagnosed Dr. Ceimo with cervical degenerative disc disease, which made it increasingly difficult for her to perform surgeries and prevented her from performing on call duties. Eventually, she was forced to stop performing surgeries as well and instead began practicing general cardiology.

In her mind, Dr. Ceimo’s new job as a general cardiologist was substantially different than her prior job as an invasive cardiologist. However, Dr. Ceimo ultimately had to sue General American, along with Paul Revere and Provident (the other insurance companies administering her claim) for the benefits she was due under her policy. She filed her disability insurance claim in 1995 and, after a long, drawn-out claim investigation, was eventually denied benefits in 1998. Due to the long delay, Dr. Ceimo was forced to continue working as a general cardiologist to meet her expenses, even though it was bad for her health and working made her pain worse.

When they denied her claim, the companies asserted that Dr. Ceimo was not a specialty cardiologist because she had only spent six to ten hours on surgeries per week. The companies then stated that her occupation before her date of disability was that of a general cardiologist, and concluded she was not eligible for total disability benefits because she continued to practice in that capacity. In making this argument, the companies ignored the fact that Dr. Ceimo had practiced invasive cardiology from when she was licensed by the Arizona Medical Board in 1982 through the onset of her disability in 1995. The companies also failed to mention that their own medical records review classified Dr. Ceimo as an “invasive cardiologist.”

Dr. Ceimo and her lawyers filed a bad faith lawsuit in the District of Arizona against General American, Paul Revere and Provident.[2] In addition to arguing that the companies improperly interpreted her specialty, Dr. Ceimo and her attorneys also asserted that the companies improperly relied on biased in-house medical consultants and internal company practices geared towards denying high-dollar physician claims like Dr. Ceimo’s. The case ultimately produced a large verdict in favor of Dr. Ceimo, with almost $6.7 million in consequential damages, but it took nearly a decade of fighting before she obtained the benefits she was due under her policy.

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 company is improperly delaying a claims determination and/or targeting your claim for denial or termination, an experienced disability insurance attorney can help you assess your claim and determine what action, if any, needs to be taken.

[1] See Ceimo v. Gen. Am. Life Ins. Co., 2003 WL 25481095 (D. Ariz. Sept. 17, 2003).

[2] They alleged that all three companies were licensed to do business in Arizona, subject to Arizona’s bad faith laws and required to abide by the Arizona Unfair Claims Settlement Practices Act.


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Arizona’s Physician Shortage

A recent study published by the Association of American Medical Colleges (AAMC) found that the U.S. is facing a growing shortage of physicians—both those in primary care and specialty care—with an estimated expected shortage of between 46,900 and 121,900 by 2032.[1]  The shortage is likely due to a number of factors such as the increased costs of going to medical school, the long hours that doctors work, doctors facing disabling conditions that interfere with their ability to practice safely, and other distractions that interfere with their ability to focus on helping patients, like lawsuits and dealing with insurance companies/bureaucratic rules/red-tape.

Arizona is not exempt from this trend, with the AAMC ranking Arizona just 42nd nationwide in the number of active primary-care physicians per 100,000 people.  This, in part, is what prompted Nebraska-based Creighton University to expand its medical program and open a medical school in Phoenix (opening in the fall of 2021).  Creighton will continue partnering with Arizona-based St. Joseph’s Hospital and Medical Center (part of Dignity Health), District Medical Group, and the Maricopa Integrated Health System.[2]  Arizona’s two other medical schools, both based at the University of Arizona, are affiliated with Banner Health.

While expanding educational opportunities can be an important next step in addressing physician shortage, an upcoming Healthcare Breakfast Panel 2019 will also look additional issues surrounding the growing shortage, including how the shortage affects other healthcare physicians, patients and employers, how technology is being used in virtual medicine, and what experts see for the future.  The panel will also look at what the passage of Arizona Senate Bill 1354, an act appropriating money from Arizona state’s general fund (fiscal year 2019-2020) to Arizona graduate medical education programs, could mean for the state.  The panel is scheduled for June 20, 2019 and is sponsored by Health System Alliance of Arizona.

[1] New Findings Confirm Predictions on Physician Shortage, AAMC News, April 23, 2019.

[2] Greg Toppo, From Omaha to Phoenix, Inside Higher Ed, Feb. 13, 2019.


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Sickness or Injury?
Why Does it Matter?

Some disability insurance policies have different rules for a sickness versus injury.  These differences can prove quite significant when it comes to your maximum benefit period.

While the difference between an injury and sickness may, initially, seem clear-cut, if you have certain disabling conditions (such as degenerative disc disease or carpal tunnel syndrome) whether you have a disabling sickness versus injury can be a very nuanced determination. For example, when a particular event causes a slowly progressive disease to become suddenly disabling to the point a dentist or doctor can no longer work in his or her occupation, the final determination may have to be made by a court.

This is what happened in a recent case before the Arizona District Court.[1] Dr. Wood was an anesthesiologist who practiced in Page, Arizona within the Banner health system. Dr. Wood suffered from degenerative disc disease in his lumbar and cervical spine, but continued to practice (a common phenomenon among physicians and dentists called presenteeism). In 2015, he and a team of nurses lifted a patient from the operating table to a hospital bed—a routine maneuver that he had done thousands of times before. This time, however, the maneuver resulted in intense radiating pain in his spine and he found himself unable to work. Dr. Wood then filed a claim with his insurer, Provident, due to the disabling back condition.

While Dr. Wood felt his disability was caused by an accident, making him eligible for lifetime benefits under the terms of his policy, Provident classified his disability as a result of sickness, and maintained he was only eligible for 48 months of benefits. Dr. Wood sued Provident and the court had to determine what “injury” meant.

Fortunately for Dr. Wood, in this case, the Arizona judge determined that the policy had a vague definition of “injury” and ruled the provision should be interpreted in Dr. Wood’s favor. The court turned to precedent set by the Arizona Court of Appeals, finding that Arizona does not distinguish between ‘accidental means’ and ‘accidental results.’”[2] The court also noted the Arizona Supreme Court’s findings that “accident” must be read in light of common speech, usage, and understanding of the average man.[3]  In the end, the court found that, under Arizona law, Dr. Wood became disabled when performing the lifting maneuver and he was eligible receive lifetime benefits.

Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are unsure of how your policy interprets sickness versus injury, an experienced disability insurance attorney can help you interpret this language and apply it to your particular situation.

[1] See Wood v. Provident Life & Accident Ins. Co., 2018 WL 2416190  (D. Ariz. May 29, 2018).

[2] Id. quoting Central Nat. Life Ins. Co. v. Peterson, 529. P.2d 1213  (Ariz. App. 1975).

[3] Id. quoting Knight v. Metro Life Ins. Co., 437 P.2d 416 (Ariz. 1968).


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Edward O. Comitz and Michael F. Beethe Named
Southwest Super Lawyers for 2019

Ed Comitz and Mike Beethe, the founding members of Comitz | Beethe, have both been named Southwest Super Lawyers for 2019.  This is the eighth consecutive year that Mr. Comitz and Mr. Beethe have been recognized by Super Lawyers for excellence in their fields, insurance coverage and real estate, respectively.

Super Lawyers is a rating service of outstanding lawyers from more than 70 practice areas who have attained a high-degree of peer recognition and professional achievement.  Only 5% of attorneys in the Southwest receive this distinction. The selection process is comprised of independent research, peer nominations and peer evaluations.

Comitz | Beethe’s primary office is located in Scottsdale, Arizona and the firm also has satellite offices in Phoenix, Arizona and Tucson, Arizona.

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What is an Independent Medical Exam?

An independent medical exam (“IME”) is an exam conducted by a doctor to verify whether you are truly disabled under your disability insurance policy’s terms.  These IMEs are rarely “independent”, and the doctors conducting them are almost always selected and paid by the insurers. In this post, we will explain what you can expect during an IME, and how you can protect yourself during the IME process.

What Can I Expect During an IME?

The IME doctor will likely begin by conducting an interview to learn about your medical history, the nature of your job, your symptoms, your treatment to date, and your daily activities.  During the interview, the doctor will be looking for signs that you are not telling the truth or that you are exaggerating your symptoms and limitations.  The doctor will pay attention to your demeanor, body language, and general appearance in order to assess your credibility.  The doctor will also compare your reported symptoms and limitations to your medical records, claim forms, and daily activities in an attempt to find inconsistencies.

Typically, the IME will largely consist of a physical examination, and the doctor may also require objective testing, such as x-rays, MRIs, or EMGs.  The doctor will often begin by conducting a general checkup, taking height/weight measurements, listening to your heart and lungs, testing your blood pressure, etc.  The doctor may then perform tests that focus on your disability and require you to provide subjective indications of pain and discomfort. He or she may ask you to bend, lift, or perform simple physical movements, depending on the nature and location of your condition.  Again, the doctor will be looking for inconsistencies or any signs that you might be exaggerating your symptoms.

After the IME, the doctor will complete a report that summarizes the findings of the exam.  The doctor will opine as to the extent of your disability, your ability to return to work, and recommended treatment or further testing.

How Can I Protect Myself in the IME Process?

As explained above, IMEs can be used as a tool for the insurance companies to deny or terminate disability benefits. Fortunately, there are ways you can protect yourself and ensure that you are treated fairly before, during, and after the IME.

Before the IME:

  • Review your policy. Most insurance policies do have a provision that allows the company to require you to submit to a physical exam.  However, these provisions are sometimes unclear as to the exact type examinations that are allowed.  Review the terms of your policy to make sure that your insurer can require you to undergo an IME.
  • Complete intake forms in advance. Your doctor will most likely ask you to complete intake forms, including questionnaires that outline your symptoms and medical history.  If you are nervous or hurried, you may forget to include important information.  Filling out the forms in advance allows you to answer each question carefully and accurately.

During the IME:

  • Bring a friend. If possible, bring a friend or family member to the IME. Not only can your friend provide moral support, but they will also serve as a witness to the exam.
  • Take notes. If possible, take notes during the IME to remember what testing was performed or what types of questions were asked. When you leave, write down your impressions and any issues you think you need to follow-up on.
  • Be cooperative and open.  Be patient and polite with the doctor.  Answer questions in a straight-forward and truthful manner, and if you do not understand something, let the doctor know. While you should be cooperative, this does not mean you need to do anything that causes you pain or injury. You know your body and limitations best, so if something the doctor asks you to do will cause you pain, let him or her know.
  • Discuss your symptoms fully and honestly. Do not minimize your symptoms and do not be afraid to complain.  It is important that your pain levels and other symptoms are documented as accurately and thoroughly as possible.
  • Connect your symptoms to your job duties. Make sure you discuss how all of your conditions impact your ability to practice safely and effectively. Give specific examples of how the conditions interfere with your practice (e.g., you cannot sit or stand for long periods without pain; you cannot manipulate dental instruments due to numbness in the fingers, etc.).

After the IME:

  • Get a copy of the report. After the exam, contact your insurer to ask for a copy of the IME report.  Review the report and compare it to your notes and recollection of the IME.  If anything needs to be clarified or there are any inconsistencies, contact your attorney and/or disability insurer as soon as possible.

If you have been scheduled for an IME, you may want to get an experienced disability insurance attorney involved.  An attorney can protect your rights during the IME process by finding out what the disability policy requires, limiting the test to certain parameters, studying the examiner’s credentials, recording the exam, accompanying you to the exam, and reviewing the final report for accuracy.

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Can You File a Disability Claim for Vision Problems?

It’s no secret that dentistry is hard work, requiring concentration, precision, visual acuity, depth perception, and quick reaction time if there is an emergency situation [1].  In prior posts, we have discussed how, as a result of these demands of the profession, musculoskeletal conditions are all too common in dentists, and often lead to dentists needing to file disability insurance claims. Similarly, a dentist who undergoes changes to his or her vision, whether via injury or disease, faces the very real possibility that he or she may need to step away from practicing dentistry early. In fact, one study showed that sight disorders were the second most common reason dentists asked for help (34.7% in females, 32% in males)[2], and the same study showed that sight disorders were recorded in 45.7% of the female dentists participating in the study and 48.5% of the male dentists, with eye injuries being the most common reported reason for seeking help.

Some eyesight injuries/impairments experienced by dentists may occur on the job, through physical hazards (radiation, artificial light) or chemical hazards (dental materials, including amalgam and dental cement particles, equipment, disinfectant, etc.).[3] Diseases of the eye are also not uncommon as one ages, and older dentists may find it increasingly challenging to effectively practice when faced with an eye disease, especially during procedures that require a significant degree of hand-eye coordination (e.g. root canals, crown procedures, etc.).

Some of the most common eye conditions in adults include age-related macular degeneration, cataracts, central retinal vein occlusion, retinopathy (due to diabetes), macular edema, glaucoma, and retinal tears and detachments. Many of these conditions can cause symptoms that can limit a dentist’s ability to practice safely and effectively (e.g. blurred vision, floaters, halos around lights, double vision, difficultly seeing in low or bright light, etc.), and over times some can even result in partial or total blindness. In addition, there are several lesser-known genetic eye conditions that can have equally devastating effects on a dentist’s ability to safely practice, including retinitis pigmentosa, choroideremia, Best disease, and cone rod dystrophy, among others.

Whether sight impairment and/or vision loss occurs through a common or rare disorder, vision problems are often slowly degenerative and progressive. In some instances, there may be ways to acceptably compensate for the vision impairment, whereas in other instances the impairment can be severe enough that it is obviously disabling. However, like other slowly progressive conditions, there is often a significant gray area between these two extremes that can be difficult to navigate if you do not have an understanding of how the disability claims process works. Dentists facing a progressive eye condition must carefully (and constantly) balance the need to keep their practice running, support their families, and continue the job they love against their duty to keep their patients safe and the risks of board complaints and/or malpractice lawsuits.

As a result, we’ve often seen dentists try to continue working even after a serious diagnosis by reducing their hours and/or the types of procedures they perform; however, doing so can hurt your chances to collect under a future disability claim, as this can undercut the severity of a claim and re-define the job duties, potentially making it much harder to establish total disability under the terms of your policy. Because of this, if you are a dentist with an eye condition that could potentially be disabling in the future, it is a good idea to have someone who is familiar with the claims process (like an experienced disability insurance attorney) evaluate your situation and start preparing a transition plan so that, if things progress to the point where you do have to file a claim, you are prepared.

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 physician do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.



Mayo Clinic,
National Eye Institute,
U.S. National Library of Medicine,
Retina International,
American Academy of Ophthalmology,
American Society of Retina Specialists,

[1] Dhanya Muralidharan, Nusrath Fareed, & M. Shanthi, Musculoskeletal Disorders among Dental Practitioners: Does It Affect Practice?, Epidemiology Research International, Vol. 2013, Article ID 716897 (2013)

[2] Marin Vodanovic, Slavica Sovic, & Ivan Galic, Occupational Health Problems and Dentists in Croatia, Acta Stomatol Croat., 2016 Dec; 50(4): 310-320

[3] Id.

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“Do You Have a True ‘Own Occupation’ Policy?”

As a dentist, you probably have purchased at least one disability insurance policy, and you probably sought out “own occupation” coverage. However, in our experience, many dentists do not understand what their policy actually says or realize that there are several variations of “own occupation” policies. Additionally, many of the newer disability policies being sold to dentists have particular requirements and “rules” that must be followed in order to qualify for benefits.

Our latest article with Dentaltown Magazine discusses some of these pitfalls and explains why it is important to know what your policy says before filing a claim. Read the full article at Dentaltown today.

10 More Legal Mistakes Professionals Make When
Filing a Disability Claim (Mistake #1)

In an effort to provide professionals with more information about how the disability claims process works and identify some of the most common pitfalls for professionals filing disability claims, Comitz | Beethe attorneys Ed Comitz and Derek Funk have compiled an updated list of the 10 most common mistakes we are seeing physicians, dentists, and other professionals make when they file claims under the new post-2000 generation of disability policies (which are much more complex and stringent than the policies sold to professionals in the 1980s and 1990s).

In this post, we’ll be looking at the common mistake of not being actively engaged in the process of selecting your disability insurance coverage.

Mistake # 1: Blindly Relying on an Insurance Agent

Many professionals who are considering purchasing a disability insurance policy rely on an agent to find the right policy for them, often providing the agent with a vague, general objective like finding the “best” policy (or the “best” policy within the professional’s budget). In our experience, we’ve also found that it is common for professionals to go to an agent that a colleague recommended, and merely ask that agent to set them up with the “same” policy that their colleagues (e.g. the other doctors in their practice) have. Or, if the professional already has a policy, he or she may ask the agent to find them a policy that is the “same” as their existing policy.

This is problematic because there are no standard policies, and the differences between the multiple key provisions in policies are difficult to explain—even for an agent. Therefore, asking for the “same” coverage is often a request that is impossible for the agent to achieve. Additionally, while input from an agent can be helpful, insurance companies rarely provide agents with adequate training or information about a policy beyond what is necessary to sell it. As a result, agents are often unfamiliar with many of the complex terms in a policy, and the agent may not know how certain key provisions will play out during the claims process (which is understandable, as they typically just sell the policies and do not have legal experience filing claims or litigating these matters).

By design, insurance companies have now explicitly placed distance between themselves and their agents, for liability purposes. Most disability policies and policy applications now contain express language stating that agents cannot alter the terms of the policy, and disclaimers stating that the insurance company cannot be held liable for representations made by an agent. In the past, an agent’s representations could modify the policy under a legal principle called the “reasonable expectations doctrine,” so we would advice insureds to keep notes of any conversations with their agents (as well as any marketing materials). This legal doctrine is now largely obsolete given this new policy language limiting the insurance companies’ liability at the point of sale.

Action Step:  If you are considering purchasing a policy, do your own research and do not rely blindly on your agent to pick your policy for you. Do not accept coverage or pay premiums for a policy until you have thoroughly reviewed the policy.

To read the rest of the 10 most common mistakes, click here.

To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.

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Doctor Money Matters Podcast
Q & A with Ed Comitz, Esq.
What Every Physician Should Know About Disability Claims

Ed Comitz recently sat down with Dr. Tarang Patel, host of the popular Doctor Money Matters Podcast, to talk through some of the most common questions physicians have about filing disability claims, such as:

  • What should a physician look for in a disability policy?
  • How hard it is for a physician to collect disability benefits?
  • Do I need a lawyer to file a disability claim?
  • What is the disability claims process like?
  • If I have an “own occupation” policy, can I work in a different occupation and still collect disability benefits?
  • What are the most common pitfalls that lead to physician’s claims being denied?

Click here to listen to Part 1 of the Podcast: and here to listen to Part 2:

Episodes can also be accessed on, and via iTunes, Google Play, Stitcher and other podcast platforms along with Facebook and YouTube.


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10 More Legal Mistakes Professionals Make When
Filing a Claim for Disability (Mistake #2)

In an effort to provide professionals with more information about how the disability claims process works and identify some of the most common pitfalls for professionals filing disability claims, Comitz | Beethe attorneys Ed Comitz and Derek Funk have compiled an updated list of the 10 most common mistakes we are seeing physicians, dentists, and other professionals make when they file claims under the new post-2000 generation of disability policies (which are much more complex and stringent than the policies sold to professionals in the 1980s and 1990s).

In this post, we’ll be looking at the common mistake of failing to carefully review your policy application.

Mistake # 2: Failing to Carefully Review Policy Applications

In many jurisdictions, the law allows insurance companies to void policies if the application for the policy contains a “misrepresentation.” Most people believe a “misrepresentation” means something akin to fraud, but now even an honest mistake can void coverage in some instances, depending on the jurisdiction. Most policy applications contain unclear, compound questions or ask for detailed medical information that may be difficult to recall on the spot, off the top of your head. Additionally, most companies also require applicants to sign a disclaimer stating that the applicant has thoroughly reviewed the application and all statements made in the policy application are true. In some cases, an agent may complete the application for the applicant, or the applicant may provide the answers to the application questions via a phone interview, further increasing the risk that an incorrect statement, omission, or misrepresentation will be inadvertently made during the application process. Accordingly, applicants should be very careful when completing policy applications, as an incorrect response to even a seemingly innocuous or unimportant question can be construed as a misrepresentation that could result in the limitation or loss of coverage.

Action Step: Rather than completing the policy application in your agent’s office, take the application home with you so that you can carefully complete, review, and sign it on your own. Then keep a copy of your application in an organized file, so you have a record of the answers you provided.

To read the rest of the 10 most common mistakes, click here.

To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.

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What is the Effective Date of My Disability Policy?

The “effective date” of a policy is the day your policy becomes enforceable. While this may seem like a simple concept, it is not always as straightforward as you might think. Understanding the date your policy became effective may require you to read several different provisions together. Additionally, if you apply for benefit increases at a later date to increase your policy’s monthly benefit, this can further complicate matters because, depending on the terms of your policy, you can end up with multiple effective dates for the same policy (corresponding to each benefit increase to the base amount).

Here is an example of a provision defining the effective date of a policy (taken from an actual policy):


EFFECTIVE – Coverage is Effective when this Policy is issued and delivered to You provided the first full premium is then paid and all answers on the application are true and complete as if made at the time of delivery.

Coverage is Effective on the Issue Date if a premium was paid at the time of the application; the Conditional Advance Premium Receipt was given at that time; and this Policy was issued at standard rates exactly as applied for.

Additional coverages are Effective on the Monthly Anniversary on or after the date We issue the new Policy Specifications containing the coverage, subject to payment at the initial premium. If the initial premium is not paid when due, the coverage will be treated as never having been Effective and new Policy specifications will be issued showing this fact.


Under this provision, there are three possible effective dates. First, the policy’s coverage will be effective when the policy is issued and delivered, as long as the first premium was paid and the application was accurate when it was submitted.

However, the provision alternatively states that the policy can be effective on the “Issue Date.” In this scenario, the policy will be effective on the “Issue Date” if: (1) a premium was paid at the time the application was completed and submitted; (2) a receipt for this payment was given to the policyholder at that time; and (3) the rates in the policy are exactly what were applied for. But what is the “Issue Date?” This is also separately defined in the policy:


ISSUE DATE – The date the Policy Specifications are printed. Subsequent Policy Specifications carry their own Issue Dates.


Finally, if the policyholder purchases additional benefits after the original policy has been issued, there is a different effective date for this new coverage (i.e. additional coverages are effective on the “Monthly Anniversary” on or after the new policy specifications are issued, as long as the first premium is paid). This requires the policyholder to understand what “Monthly Anniversary” (another separately defined term) means:


MONTHLY ANNIVERSARY – [This date is] computed from the Policy Date shown in the Policy Specifications…. The Monthly Anniversary is the same date in each succeeding month as the Policy Date.


So, as you can see, under some policies, determining when your coverage becomes effective (and/or whether benefit increases apply to your claim) can be particularly complicated and depend on the particular facts at play. Disability insurance policies—particularly newer disability policies—are complex documents, and insurers often take advantage of this complexity when denying claims. If you are having difficulty understanding your policy’s provisions, an experienced disability insurance attorney can help you interpret confusing policy language and apply it to your particular situation.

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Disability Insurer Profiles #10: Unum

Unum, originally called Union Mutual, was founded in 1848. Over the years, Unum has merged with additional companies such as Colonial Life and Provident (which had acquired Paul Revere) to form one of the largest insurance companies in America.[1] In 2017, Unum’s total revenue reached $11.3 billion, with total assets of $64 billion.[2]

In 2004, Unum was the subject of a multistate market conduct examination which identified the following inappropriate claims handling practices: (1) excessive reliance on in-house medical staff; (2) unfair evaluation of attending medical examiner notes; (3) failure to evaluate the totality of the claimant’s medical condition; and (4) an inappropriate burden placed on the claimants to justify eligibility for benefits. Following the 2004 investigation, Unum was required to reform its claims practices and pay a fine of $15 million. Unum was also required to reassess certain denied claims stretching over a seven year period. It is estimated that compliance with the settlement cost Unum around $120 million.[3]

If you are a dentist or physician with a Unum policy and are thinking about filing a disability claim, you should be prepared for an in-depth evaluation of your occupational duties. When a disability claim is filed by a professional, the amount of money at stake is significant. One way for the companies to save money is to deny the claim. Another is to maintain that the claim is not a “total disability” claim, but rather a “residual disability” claim, so they only have to pay a fraction of the full monthly benefit amount.

Whether a claim is a “total” or “residual” disability claim often come down to how the duties of your pre-disability occupation are defined in the context of your claim. Then, the insurer assesses whether it can argue that you can still perform any of those duties, taking into account what your medical records report regarding your limitations and any post-disability job or volunteer activities you may be engaging in. Even if your policy allows you to work in another occupation and still collect benefits, the insurance company may argue that your new job has overlapping job duties with your prior occupation, and therefore you are only partially disabled.

For example, in Ogborne v. Unum[4], a dentist filed a disability claim with Unum after suffering a ligament injury to his right index finger. His doctors told him that his injury would be slow healing, and eventually told him that his injury was permanent. Unum denied his claim, stating that he had given untimely notice of the claim and that the dentist was not “totally disabled” because his particular injury only prevented him from performing “two types of procedures.” Unum also relied on the fact that the dentist had returned to work and was making more money than he had before the injury.

The dentist and his attorneys sued to challenge the denial, and the court determined that Unum was improperly interpreting the definition of “total disability” under the policy, which defined “total disability” as “the inability of the Insured to perform the duties of his regular occupation.” The court observed that “[t]his definition is susceptible to two different, yet reasonable, interpretations: namely, that the insured is totally disabled if he cannot perform either more than one of his pre-injury duties or all such duties.” Then the court determined that the ambiguous language should be construed against Unum, as the drafter of the contract.

Next, the court determined that the dentist had, in fact, produced evidence demonstrating that he was unable to perform several of the duties of dentistry, including root canals, periodontal work, and root scaling. Ultimately, the court ordered Unum to overturn the denial, but it took several years and a favorable decision from a judge to get Unum to pay benefits.[5]

These are just a few examples of things to be aware of if you have a Unum policy or claim with Unum. Unum policies are not all identical, and they are updated frequently. Your policy may or may not include the provisions mentioned above. If you are considering filing a disability claim, you should consult with an experienced disability insurance attorney to learn more about your policy and any potential issues related to your particular claim.





[4] Ogborne v. UNUM Life Ins. Co. of Am., No. 3:04CV7231, 2006 WL 2505905, at *2 (N.D. Ohio Aug. 28, 2006).

[5] It should be noted that this particular case was also decided under Ohio law. As the law regarding how disability policies are interpreted varies from state to state, this case could have come out differently in a different jurisdiction.


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10 More Legal Mistakes Professionals Make When
Filing a Claim for Disability (Mistake #3)

In an effort to provide professionals with more information about how the disability claims process works and identify some of the most common pitfalls for professionals filing disability claims, Comitz | Beethe attorneys Ed Comitz and Derek Funk have compiled an updated list of the 10 most common mistakes we are seeing physicians, dentists, and other professionals make when they file claims under the new post-2000 generation of disability policies (which are much more complex and stringent than the policies sold to professionals in the 1980s and 1990s).

In this post, we’ll be looking the common mistake of failing to watch out for the limitation provisions that insurance companies are adding to newer disability policies.

Mistake # 3:  Failing to Understand the Limitations in Newer Disability Policies

Professionals should carefully review their policies to make sure they understand the scope of coverage provided. An important consideration in evaluating a new policy now involves whether it imposes conditions on eligibility for benefits that conflict with those imposed by an existing policy. For instance, one policy may only pay total disability benefits if an insured is unable to work in his prior occupation and is working in another occupation (an “own-occupation” policy with a “work” provision), whereas another policy may provide benefits only if the insured is not working in another occupation (an “own-occupation” policy with a “no work” provision). Thus, if you are not careful and intimately familiar with the terms of your existing policy or policies, you can end up purchasing a new policy (and paying years of premiums) for coverage that is essentially worthless (because it is impossible to collect benefits under both policies at the same time). Some policies even have “offset” provisions that deduct the amount of benefits you receive if you receive disability insurance benefits from other sources.

It is also important to take note of limitations or exclusions in the policy that may limit recovery for certain conditions. Many policies contain limitations on benefits for disability caused by a mental illness or an illness with largely subjective symptoms that cannot be verified with objective testing. Other policies that provide for lifetime benefits may permit lifetime recovery for disabilities caused by “injury,” but place a limitation on disabilities caused by “illness or disease.”

Action Step:  When you receive the full policy, read it cover to cover and make sure you are aware of all of its terms, conditions, and limitations.

To read the rest of the 10 most common mistakes, click here.

To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.

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Disability Insurer Profiles #9: Standard

Standard Insurance Company (also branded as “The Standard”) is one of the largest disability insurance companies in operation, with over $4.3 billion collected annually from premiums.[1]

If you have a Standard policy, you will want to pay close attention to how disability is defined under the policy, as Standard policies can contain provisions that shift from “own occupation” coverage to “any occupation” coverage after a certain period of time.[2] Because of this, Standard will sometimes approve a claim initially, but then reassess and terminate the claim when the more stringent “any occupation” provisions kicks-in later on.

For example, in Pringle v. Standard Insurance Company, Standard initially found the claimant to be disabled due to bilateral shoulder pain, bilateral knee pain, and numbness in his legs, feet and toes. Later on, after the “any occupation” definition replaced the “own occupation” definition of disability, Standard terminated the claim (and subsequently denied the claimant’s appeal of the claim termination) even though the claimant’s treating physicians had all opined that he could not work.

In support of its termination decision in Pringle, Standard relied on memos produced by its physician consultants after file reviews of the medical records. Notably, while other companies often only have one doctor conduct a file review of the record when evaluating whether to deny a claim, Standard in this case paid three doctors of various specialties to review the record and author peer review reports. Accordingly, if you have a Standard policy, it is important that you have supportive doctors and accurate and up-to-date medical records that support your claim, because you may have to go up against multiple physician reports if your claim is denied.

Another tool that Standard uses is the peer-to-peer call, where it assigns a doctor to contact your treating physicians to discuss your claim. This can be problematic, because the doctors hired by Standard (and other insurers) are often adept at asking trick questions, and don’t always explain the significance of how key terms like “own occupation” or “total disability” are defined in your particular claim. After the call, the insurance company’s doctor will typically prepare a letter “summarizing” the call in a way that favors the insurance company, in the hopes that your doctor (who is likely very busy) signs off on it without reading it carefully.

In the Pringle case, mentioned above, Standard’s doctor conducted this sort of call and the follow-up letter to the primary care doctor stated, in part, “you indicated the claimant was a ‘muscular guy’ and that, from your perspective, the claimant could function at a sedentary capacity as people in wheelchairs and who have had amputations are capable of working at a sedentary capacity.” According to the case record, the primary care doctor ended up signing off on this statement, even though it is arguably inconsistent with what the primary care doctor stated in his prior records and opinions (raising the question of whether he, in fact, read it before signing and sending it back to Standard). Ultimately, in Pringle, the court reversed the termination and required Standard to pay back benefits, but it took several years of costly litigation in order to get the denial reversed and the benefits reinstated.

These are just a few examples of things to be aware of if you have a Standard policy or claim with Standard. Standard policies are not all identical, and they are updated frequently. Your policy may or may not include the provisions mentioned above. If you are considering filing a disability claim, you should consult with an experienced disability insurance attorney to learn more about your policy and any potential issues related to your particular claim.


[2] See, e.g., Pringle v. Standard Ins. Co., No. 3:18-CV-05025-RBL, 2019 WL 912297 (W.D. Wash. Feb. 25, 2019).


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