Disability Insurance: Do I Really Need It?
A Disability Insurance Attorney’s Perspective
By: Derek R. Funk, Esq.
More than 1 in 4 of today’s 20-year-olds will become disabled before reaching retirement age, according to the Social Security Administration.[i] A recent study ranked dentistry as one of the most hazardous careers, outranking firefighters, nuclear equipment operation technicians, and oil and gas derrick operators.[ii] And dentists are also near the top of the list for risk of COVID-19 infections, the long-term consequences of which remain largely unknown.[iii]
In our practice, which focuses on professionals’ “own occupation” disability claims, the majority of our clients are dentists. Many are in their late 30’s or 40’s and never expected to be facing a disabling condition at the height of their careers.
Bottom line—if you are a dentist, you should have a plan for protecting yourself financially if you can no longer practice.
What are the Most Common Reasons Dentists File for Disability?
Many dentists view disability insurance as something they only will need if there is a catastrophic event and they are severely injured. However, the most common dentist disabilities we see are slowly progressive musculoskeletal disorders, mental health conditions (such as panic and anxiety disorders), and progressive vision loss. These conditions may seem less dramatic than the loss of a limb or a serious accident, but are just as devastating for dentists who rely heavily on their sight and need to be able to sit for extended periods of time, keep their hands steady, and operate with precision within very small confines and margins.
Notably, the Council for Disability awareness has also found that musculoskeletal disorders, such as arthritis, back pain, and spine/joint disorders, are among the leading causes of disability.[iv] For dentists, the risk of these disorders ending their careers is heightened, as a dentist can spend up to 60,000 hours in a lifetime working in tense and distorted positions.[v] Many of these conditions are chronic and exacerbated by the practice of dentistry. Over time they can progress to a point where continuing to practice not only jeopardizes patient safety, but also the health of the dentists themselves.
What Do I Need to Be Aware of if I Think I May Need to File A Disability Claim?
Hopefully, you will be able to practice safely, without interruption, and retire on your own terms. But if you do end up facing a disabling condition, it is important that you go into the claim informed and prepared.
Understand Your Policy
Most dentists know that they should purchase “own occupation” policies. However, many dentists are not aware that there are several variations of “own occupation” policies that are not true “own occupation” policies.
A true “own occupation” policy allows you to earn income in a new occupation and collect your full total disability benefit.
When dentists come to us needing to file a claim, virtually all of them believe that they have a true “own occupation” policy because they asked for an “own occupation” policy and, when they received it, they checked for the phrase “own occupation” in the policy schedule or summary. However, many policies use the phrase “own occupation,” but add additional qualifications or limitations that you may not be expecting.
Here are just a few examples of some common variations that use “own occupation” language but are not true “own occupation” policies:
- Own-Occupation with “Offset/Work” Provisions: These provisions reduce your benefit amount if you work post-disability, even if it is in a different occupation. Sometimes these provisions go so far as to require you to work in another capacity, if you are able, and give the insurer the ability to offset benefits as if you were working full-time if they think you can go back to work.
- Own-Occupation with “No Work” Provisions: These provisions cut off your benefits if you go back to work post-disability—even in a job that is completely different than your prior occupation.
- Shifting “Own Occupation” Provision: These provisions allow you to receive benefits based on your inability to work in your prior occupation, but only for a limited period of time (usually somewhere between 2 to 5 years). After this window has passed, you can only continue to receive total disability benefits if you are unable to work in any occupation.
If your policy has one of these “own occupation” variants, it does not necessarily mean that you cannot collect or that you should give up on your claim. However, it does mean that you need to read your policy carefully and understand how it works before you file, so that you are prepared to make a claim that is consistent with what is permitted under your policy.
Additionally, if you have a policy that allows you to transition to new employment, insurers will closely scrutinize whether the new job has any overlap with your prior occupation’s duties. Accordingly, if you are a specialist, it can also be helpful if your policy contains a specialty-specific definition that defines your occupation narrowly as the specialty you were practicing prior to the onset of your disability.
Understand the Process
Many dentists assume that all they need to do to collect disability benefits is notify the company that they cannot work and provide a signed statement from their doctor confirming that they are disabled. However, the process is much more involved than that.
Unlike other insurance claims, most disability policies require you to continuously establish your ongoing eligibility for benefits each month. Each month, the company takes into account any new developments and makes a new determination as to whether you remain disabled under your policy. Even if your disability claim is initially approved, further evaluations and investigations can (and do) occur throughout the lifetime of the claim.
Be Prepared for the Claim Investigation, Which Often Begins at First Contact
Many disability insurers are now interviewing dentists in the very first call that the dentist makes to request a claim packet. The length of these calls and the questions asked vary depending on the insurer. However, at a minimum, you should not call in to request a claim packet until you understand how your policy works and the nature of the claim you are making.
Disability policies are complex and often provide for multiple types of benefits designed to apply to different situations. Before filing a claim, dentists should read through their policies and consider the following:
- Does my policy allow for total or partial disability benefits, or both? Am I filing a total disability or partial disability claim?
- Do I have a true own occupation policy? Can I work and collect benefits? Will working in a new job offset or otherwise impact my benefits under my policy?
- Am I keeping or selling my practice? Am I hiring an associate? How will this impact my claim?
- Do I have a sufficient treatment history to prove up my disability? What is the long-term treatment plan? Does it fit with the care requirements for my policy? Is surgery an option? How will I respond if the insurer pressures me to undergo surgery?
- How is occupation defined under my policy? Do I have a specialty-specific policy? Have I been practicing in my specialty? Have I modified my occupation by changing my duties, reducing my hours, or beginning a new job?
This last point trips up a lot of dentists because many disability policies now define your occupation as the “occupation or occupations” that you were engaged in prior to the date of disability. When facing slowly progressive conditions, many dentists cut back their hours and look for other, non-clinical ways to generate income. Depending on the policy, this can limit a dentist’s ability to qualify for certain disability benefits later on. Consequently, if you have a slowly progressive condition, you should not make these types of changes without evaluating how they could affect a future disability claim.
What Should I Expect Once the Claim Has Been Filed?
If a dentist is facing a permanent disability and has several years left on his or her policy, the company can end up paying out millions of dollars over the lifetime of the claim. Because of the significant amount of money at stake, insurance companies often devote significant time and resources into investigating dentist claims.
While each claim is different, over the course of a claim investigation, insurance companies will typically:
- Seek to speak with others about your condition. This may include treating providers, pharmacies, insurance agents, financial institutions, the Social Security Administration, family, friends, co-workers and employees, among others.
- Seek to gather a wide range of documentation for their file, beyond what they request from you directly. This may include medical records, tests, or consultations, prescription history, mental health records, records for substance abuse treatment, court records, occupational data, employment history, driving history, financial statements, and/or your earning history.
- Schedule face-to-face interviews with you. Many insurers seek to interview you in your home, so that they can view your surroundings to see if they can find discrepancies in the claim, or learn more about you so that it is easier for them to conduct surveillance.
- Order an In-Person Exam. The insurance company may claim that an in-person exam is needed to verify a disability. In some instances, this may be the case. However, some insurers use these exams to criticize your provider’s course of treatment, dispute your own provider’s conclusions and diagnoses, or challenge your reported limitations (particularly symptoms that are subjective in nature, such as pain and numbness). Most disability policies also provide that refusal to participate in an exam allows the insurance company to deny a claim or terminate benefits.
- Use a private investigator to conduct surveillance. The insurance company may employ a private investigator to conduct photo, video and/or online surveillance, in an attempt to find discrepancies in your claim or evidence of “malingering.” This can pose a particular challenge for dentist claims, as oftentimes a dentist’s symptoms and limitations may be nuanced and/or significantly alleviated once he or she steps away from the demands of practicing.
This process can feel very invasive and, if you have never experienced it before, it can be hard to tell whether your insurer is taking things too far. If you feel your insurance company is being too aggressive, an experienced disability insurance attorney can help you to assess the scope of the investigation and advise whether the insurer has engaged in any improper conduct.
Do I Need an Attorney/How Do I Know If I Have Complex 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 from the waist down—in our experience dentist claims are typically not that straightforward. As noted above, many of our clients have more nuanced conditions, such as slowly progressive radiculopathy 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 dentist. 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 are often costly, stressful, and, in some instances, can drag out over several years. Even if you prevail it can be an exhausting process.
Consequently, in our view, it is more prudent to approach your claim carefully from the outset and address any concerns that the insurer may have over the course of the investigation itself, so that you are not placed in a position where benefits have been cut off and your only option is a lawsuit. In our experience, the most common areas where complexities can arise in dentist claims include:
- The timing of the claim (particularly in situations where a disabling condition is slowly progressive);
- Claims made by dentists who own their practice and need to decide whether to sell, bring on new associates, or keep working in a limited capacity;
- Claims where the underlying condition is a diagnosis by exclusion;
- Claims involving multiple co-morbid conditions;
- Claims involving recommendations for or against surgery; and
- Claims involving mental health conditions.
This is not an exhaustive list, but if your claim encompasses one or more of these areas, it is a good idea to at least consult with a disability attorney to determine what issues may arise over the course of your claim.
If you are a dentist, you should have disability coverage that protects you if you can no longer practice. If you need to file a disability claim, you should take it seriously and not go into the claim blindly. If you are not able to locate a copy of your policy, request a duplicate and keep it in a safe place so that you have it if you need it. Before selling your practice or making changes to your occupation, you should carefully consider how those decisions could impact your ability to collect under your particular policy. And if you believe that there may be any issues with your claim, you should speak with an experienced disability attorney as early as possible so that you can ensure that those issues are properly addressed and resolved.
* Derek R. Funk, Esq. is an attorney licensed in Utah and Arizona. His practice is solely dedicated to handling professionals’ “own occupation” claims and he works with dentists at all stages of the disability claims process.
The information in this article has been prepared for informational purposes only and does not constitute legal advice. Anyone reading this article should not act on any information contained herein without seeking professional counsel from an attorney. The author and publisher shall not be responsible for any damages resulting from any error, inaccuracy or omission contained in this publication.
[i] See Social Security Administration, Facts, https://www.ssa.gov/disabilityfacts/facts.html, last viewed Dec. 7, 2020.
[ii] Andy Kiersz, The 32 most dangerous jobs for your health, Business Insider, Mar. 8, 2019.
[iii] See Franziska Beier, DTI, SARS-COV-2: Dentistry tops list of most dangerous jobs, Dental Tribune, June 23, 2020.
[iv] Council for Disability Awareness, What Are the Most Common Causes of Disability?, https://disabilitycanhappen.org/common-causes/, last viewed Dec. 7, 2020.
[v] A. Grupta, et al., Ergonomics in Dentistry, Int J Clin Pediatr Dent 2014; 7(1):30-34).