Ed Comitz, the head of Comitz | Beethe’s Disability Insurance and Healthcare Law practice, has been named as an Arizona Business Leader in 2017 by Arizona Business Magazine. The 500 business leaders were selected from a pool over of 5,000 names considered. Editor in Chief, Michael Gossie, writes of the 500 leaders selected, “They are catalysts for Arizona’s economy. They are leaders. They are innovators. They have influence. And when they speak, they make things happen.”
As we have discussed in previous posts, musculoskeletal disorders are very common among dentists due to the repetitive movements and awkward static positions required to perform dental procedures. Unum, one of the largest private disability insurers in the United States, recently released statistics showing an increase in the filing of musculoskeletal disability claims over the past 10 years.
According to Unum’s internal statistics, long term disability claims related to musculoskeletal issues have risen approximately 33% over the past ten years, and long term disability claims related to joint disorders have risen approximately 22%. In that same period of time, short term disability claims for musculoskeletal issues have increased by 14%, and short term disability claims for joint disorders have risen 26%.
This trend may lead to Unum directing a greater degree of attention towards musculoskeletal claims as the volume of these claims continues to increase. Musculoskeletal claims are often targeted by insurance companies for denial or termination because they are easy to undercut—primarily due to the limitations of medical testing in this area. For instance, it can be difficult to definitively link a patient’s particular subjective symptoms to specific results on an MRI, and other tests, such as EMGs, are not always reliable indicators of the symptoms that a patient is actually experiencing. Insurers also typically conduct surveillance on individuals with neck and back problems in an effort to collect footage they can use to deny or terminate the claim. While such footage is usually taken out of context, it can be very difficult to convince the insurance company (or a jury) to reverse a claim denial once the insurer has obtained photos or videos of activities that appear inconsistent with the insured’s disability.
As we have noted in a previous post, Unum no longer sells individual disability insurance policies, so its disability insurance related income is now limited to the premiums being collected on existing policies. Because benefit denials and termination are the primary ways insurers like Unum can continue to profit from a closed block of business, and musculoskeletal claims are on the rise, Unum may begin subjecting this type of claim to even higher scrutiny.
Lump sum buyouts are a frequent source of questions from our clients and potential clients. With that in mind, the next few posts will address different aspects of the buyout process.
Buyouts typically occur in one of two situations: 1) after you’ve been on claim for several years, or 2) after a lawsuit has been filed. This blog post will focus on the first scenario.
Lump sum buyouts that occur outside of litigation normally won’t occur unless and until the insurance company decides that you are totally and permanently disabled under the policy definition. Typically, the disability insurer won’t consider whether this is the case until you’ve been on claim for at least two years. If the insurer determines that you’re totally and permanently disabled, it will then determine whether it makes sense financially for the company to offer you a percentage of your total future benefits rather than keep paying your monthly benefits for the entire duration of your claim.
To understand how the insurance company calculates whether a buyout is in its financial interest, you should understand how insurance company reserves work. The purpose of reserves is to ensure that the insurance company has the resources to fulfill its obligations to policyholders even if the company has financial difficulties. Thus, disability insurers are required by state regulators to keep a certain amount of money set aside, or “reserved,” to pay future claims. Any money required to be kept in a reserve is money that the insurer can’t spend on other things or pay out in dividends. The amounts required to be kept in the reserve are determined by the state, depending on factors like how much the monthly benefit is and how long the claim is expected to last.
For a disability insurance claim, a graph of the required reserve amount over time looks like a Bell curve: low at the beginning, highest in the middle, and low again towards the end of the benefit period. The ideal time for a settlement, from an insurance company’s perspective, is at or just before the high middle point–typically about five to seven years into the claim, depending on the claimant’s age and the duration of the benefit period. At this point, the company is having to set aside the highest amount of money in the reserve.
If the insurance company can pay you a percentage of your total future benefits, it can not only save money in the long run, but it can release the money in the reserve. The disability insurer can then use those funds for other purposes, including providing dividends for its investors. In addition, the insurance company will save all of the administrative expenses it was putting towards monitoring your disability claim.
In the next post, we’ll address how and why buyouts occur after a lawsuit has been filed.
Alzheimer’s disease is a serious disability that can dramatically impact a physician or dentist’s ability to practice. In this post, we will be looking at some of the risk factors associated with Alzheimer’s, some of the signs that may indicate the onset of Alzheimer’s, and some of the proposed methods of treating Alzheimer’s.
Alzheimer’s is a form of dementia that affects memory, thinking, and behavior. There are three primary risk factors for Alzheimer’s:
- Age: Most people that have Alzheimer’s are 65 or older, and the likelihood of developing Alzheimer’s doubles every five years after age 65.
- Heredity: Scientists have identified certain “risk” genes that can contribute to the risk of developing Alzheimer’s. Amyloid precursor protein (APP), presenilin-1 (PS-1), and presenilin-2 (PS-2) are proteins that directly cause Alzheimer’s, although “deterministic” Alzheimer’s occurs in only 5% of cases. APOE-e4 is another gene that scientists believe may be a factor in 20 to 25% of cases, although they are not sure precisely how it increases the risk.
- Family History: People who have parents, siblings, or even children with the disease are more likely to have Alzheimer’s. The risk also increases as more family members develop the disease.
The Alzheimer’s Association lists 10 warning signs that may indicate the onset of Alzheimer’s: Continue reading “Alzheimer’s: Is there a Helpful Drug on the Horizon?”
In previous posts, we have discussed how courts and juries have reprimanded Unum and its various subsidiaries for wrongfully denying disability claims. Now, Unum is once again making the headlines—this time for making significant changes to its leadership at the highest levels of the company.
Essentially, Unum is undertaking a widespread overhaul of its upper management. Marco Forato is now the senior vice president for global growth strategy, Steve Mitchell is the new chief financial officer, and Steve Zabel is the new president of the U.S. closed block operations. Additionally, Vicki Gordan has been promoted to senior vice president and chief internal auditor, and Matt Royal is now the chief risk officer for Unum.
While any change of leadership can have substantial ramifications, those insured by Unum should take particular note that Unum has appointed a new “president of the U.S. closed block operations.” “Closed block” refers to Unum’s discontinued product lines, which, according to Unum’s 2014 Annual Report, include long-term care and older individual disability policies. If you are a physician or dentist with a Unum policy, your policy is probably part of Unum’s “closed block” operations.
Unum’s new president of “closed block” operations will likely face a challenging task because any losses suffered from paying out Unum’s old disability policies cannot be offset by new business. Additionally, such “closed block” operations are a relatively new phenomenon in the insurance industry, so there is a very small reserve of historical data for Unum to draw upon.
What does this mean?
Generally speaking, a company does not make such extensive changes without expecting results. Consequently, it is likely that several, if not all, of Unum’s newly appointed leaders will be under substantial pressure to perform. Because fresh leaders often want to leave their own mark on their industry, insureds should pay close attention to any new changes in policy announced by Unum during this transitional period.
More specifically, insureds with older individual disability policies with Unum should be aware that Unum will likely be looking for new, creative ways to deny their claims. If you have such a policy and you feel that Unum has arbitrarily changed your policy’s terms and/or wrongfully denied your disability claim, you should consult with an experienced disability insurance attorney to ensure that Unum’s leadership is not improperly exceeding the scope of their newly acquired authority.
Good posture is important for everyone, but especially for dentists, who spend a fair amount of time in static positions, making repetitive movements, or bending or twisting in ways that aren’t necessarily natural for human bodies. Today, we’re going to give you some tips on how to improve your posture and positioning in your everyday life as well as your practice, so that you may potentially avoid or delay future disabling pain.
- Keep your body in alignment.
- While standing, this means distributing your weight evenly on both feet, and making sure that you keep your weight from shifting either forward on the balls of your feet or backward on your heels.
- When seated, sit up straight and keep your ears, shoulders, and hips in a straight line. A good trick is to picture a balloon attached to the top of your head, pulling you upward.
- Move around a bit.
- When your muscles get tired, it’s much easier to slouch or fall into a position that might be comfortable now, but could strain parts of your body you don’t want strained. It’s important to walk around after every half-hour or so of sitting to stretch and refresh your body.
- Also, moving around slightly while seated is a good way to refresh your muscles. Instead of making your back tight by forcing a constantly straight position, bend a little bit every now and then to reset your posture, and give yourself a break.
- When working at a desk, use a chair that has good lumbar support or use a small pillow placed between your back and the chair.
- The spine naturally curves in an “S” shape, so it is important to support your lower back. Ergonomically designed chairs can do this. Using a small pillow for your lower back can also help support your spine.
- It is also important to sit back in your chair and not on the edge of the seat. A chair is able to provide a solid foundation for your seat only if you use all of the area.
- Make sure your desk chair is properly aligned to your workspace.
- Keep your feet flat on the floor and have your hips slightly higher than your knees when sitting at a desk. This will keep you from adding strain to your hip flexor muscles, which play a role in lower back stability.
In the Dental Chair
- Keep your patient at waist level.
- This enables you to maintain your proper posture and work safely within your patient’s mouth. It also helps keep your wrists straight, and elbows at 90 degrees, which puts less strain on your arms, shoulders and back.
- To test it out, hold a 5–pound weight away from your body at waist–height and slowly move it in until your elbows are at 90 degrees. Notice how the weight is much more comfortable to hold when it is closer to your body.
- Have your tools easily available.
- Keep everything you may need within a short reach and in front of you so you don’t do any unnecessary twisting, bending or turning.
- Have better designed tools.
- You can get lighter tools and angled hand-pieces that allow you to better reach difficult places in your patient’s mouth. It would also be helpful to replace old hoses with ones that are designed to be lighter and straight, so you don’t have to fight the tension of a coil.
- Gloves are also important: using ambidextrous gloves forces your thumb into an unnatural position and constrains your fingers into one plane, which isn’t anatomically correct. Look into purchasing gloves specifically for your left and right hands to avoid this strain.
While all of these tips can be helpful in preventing future pain, none of them are a cure-all for potential disabilities, and they may not “fix” pain that has already begun. It is essential to have a dialogue with your doctor about any issues that you may be having. It may also be useful to talk to a disability insurance lawyer if you think that your current or future pain may not allow you to continue practicing. We hope that these tips were helpful; let us know in the comments what worked for you!
Protecting the Protectors: Depression, Medical Professionals, and the Conflicts Involved with Under-reporting
Today we’re taking a closer look at how depression can affect doctors and dentists, their practices, and the way they file for disability insurance. We examine how the medical community’s approach toward mental health is perhaps preventing some doctors from reporting illness, and how this changes a doctor’s ability to obtain adequate treatment and secure disability insurance benefits.
Depression and anxiety are undeniably prevalent among physicians and dentists. For instance, a study in Australia showed that the rates of depression in doctors is four times higher than the general population and in a British study, 60% of dentists surveyed reported being anxious, tense, or depressed.
Simply looking at the daily life of doctors, and comparing that to the risk factors for depression shows some striking connections between the two. Some of the risk factors associated with depression (as outlined by the Mayo Clinic) include being overly self-critical, having serious or chronic illness and dealing with traumatic or stressful events. Interestingly, these are many things that doctors and dentists struggle with; indeed, probably more often than the average person. Doctors and dentists have to be self-critical because if they aren’t, lives could be at stake. In addition, doctors and dentists often suffer from chronic illness and pain due to the physically and emotionally taxing nature of their work. Worrying about patients, running a practice, and working long hours are all part of the job description for the average doctor.
While physicians and dentists commonly have symptoms of depression, they often don’t report their issues due to the stigma of mental health issues within the medical community. Lay people look to doctors and dentists as the paragon of health, and physicians take the same approach: while their patients are characterized by their illness, physicians are supposed to be the ones who cure them. While the general populace’s approach to mental illness has improved greatly over time (we no longer lock people in tiny jail cells simply because they are mentally ill), the negative stigma attached to depression and anxiety in the medical and dental community is still present. In the Australian study noted above, half of the respondents reported thinking that they were less likely to be appointed to a new position if they had a history of mental illness, and 40% admitted thinking less of doctors that have a history of depression or anxiety.
Nevertheless, it is important for doctors to recognize whether they exhibit signs of mental illness. Aside from needing to be mindful of their own health and well-being, doctors are responsible for the health and well-being of their patients, too. Physicians and dentists both are in the unique position that a mistake that they make at work could endanger a life. Attempting to work through depression and anxiety symptoms that impair the doctor’s ability to provide responsible patient care could lead to a malpractice suit. Perhaps the solution to this issue is a re-evaluation of the medical community’s approach to mental illness. While that seems like a large task to take on, it starts with each individual doctor either seeking treatment for mental health, or supporting those that do.
For physicians, states have programs in place called Physician Health Programs (PHPs) that are supposed to support the health, including mental health, of medical licensees. A PHP is advertised as a way to get the help one needs, while avoiding disciplinary action such as a loss of license. Physicians should be aware, however, that PHPs are often connected to the licensing boards, and non-compliance with the PHP can lead to disciplinary action. For example, in Arizona, while the PHP is operated by an independent agency, it does have a formal contractual relationship with the state licensing board.
Firm member Patrick Stanley, whose practice areas include disability insurance and healthcare litigation, was selected as a Sustaining Member of Arizona’s Finest Lawyers. Nominations to Arizona’s Finest Lawyers are governed by strict ideologies and are made by Sustaining Members, selectees, and members of the Executive and Advisory Boards. The AFL seeks to build a diverse membership of individuals who, through noteworthy achievement, have reached positions of honor and trust. A Sustaining Member must be highly skilled, have a well-known reputation for honor and professional behavior, and be dedicated to AFL’s mission and goals.
Edward O. Comitz, the head of the healthcare and disability insurance law practice at the Scottsdale law firm of Comitz | Beethe, has been selected as an Arizona Business Leader in the area of Healthcare Law. According to the editor in chief, Arizona Business Magazine made its final selections from a pool of over 5,000 of “the best and brightest Arizona business leaders in healthcare, real estate, construction, education, banking, financial services and law. Over the course of more than two dozen meetings, that list of 5,000 leaders under consideration was pared down to about 500 names, which the selection panel considered to be the most influential leaders in their industries, broken down into categories.”
Other Arizona leaders named in 2015 include U.S. Senator John McCain, Phoenix Mayor Greg Stanton, and sports executive and former owner of the Phoenix Suns, Jerry Colangelo.
UPDATE: Since this story was originally posted in 2008, the insurance regulators of Maine and Massachusetts initiated targeted market conduct examinations of CIGNA’s disability claims handling practices. The concerns raised by Maine and Massachusetts prompted the insurance commissioners of Connecticut and Pennsylvania to also open market conduct examinations and for the California Insurance Commissioner to reopen his previous examination of CIGNA. In 2013, the examinations resulted in fines against the CIGNA companies, corrective actions being required in its handling of disability claims, and for CIGNA to reevaluate certain claims that were denied or terminated. Information on the CIGNA Multi-State Regulatory Settlement Agreement can be found here.
ABC News/Good Morning America‘s investigation by Chris Cuomo into CIGNA disability claim denials has uncovered some disturbing stories. In the video above, claimants describe some of the hardships they have been forced to endure due to denials of their claims or unreasonable delays in having their claims paid.
One breast cancer survivor, who eventually was paid on her claim with the assistance of a disability insurance attorney, describes her two-year ordeal with CIGNA as a “daily, eight-hour job just to fulfill the information that CIGNA was requesting.” The tactic of wearing down a disabled claimant with repeated requests for documentation that has already been provided multiple times — thereby deliberately delaying payment of the claim — is called “slow walking” by some in the industry. While CIGNA denies engaging in this practice, many claimants who are already emotionally and physically vulnerable due to their disability will eventually quit pursuing benefits to which they are entitled in this battle of attrition that is widespread in the disability insurance industry. In this situation, it is often necessary for a claimant to retain the services of an attorney, not only to take on legal issues with the insurance company but also to shoulder the burden of the excessive and repetitive requests for documentation.
Other claimants in Chris Cuomo’s GMA piece describe (a) three years of fighting CIGNA for their benefits, all the while sinking deeply into debt and losing everything; (b) being caught between a rock and a hard place when told by an employer that he could not return to work due to his disability, but simultaneously having CIGNA deny disability benefits; (c) purchasing insurance to protect herself and her family, only to have her business destroyed, savings depleted and fighting to keep her family home when benefits were denied or delayed.
Another of the claimants profiled, Ursula Guidry, a young wife and mother with advanced breast cancer, initially had her benefits paid by CIGNA, but after awhile, they terminated her benefits and told her she could return to work full-time. Eventually CIGNA settled the claim with her. She passed away three months later. As her husband says, it is tragic that her last year on earth was spent being in a panic over financial issues and fighting an unethical insurance company instead of enjoying as much time as possible with her husband and children.
CIGNA did not respond to GMA re any of the specific claimants profiled, but their Chief Medical Officer stated they pay 90% of disability claims filed and that the majority of their customers are satisfied.
Scottsdale attorney Edward O. Comitz was recently consulted by the popular financial website The Street regarding his thoughts on whether it’s a good financial decision to purchase an individual disability insurance policy. Based on the high premiums and his experience as an attorney who specializes in assisting sick or injured claimants with obtaining the individual disability insurance benefits to which they are entitled, Mr. Comitz advised that, with the exception of medical professionals such as dentists and surgeons – for whom even a minor injury can be career-ending – disability insurance is not a good investment unless you are also prepared to incur the costs of hiring an attorney if your claim is denied or terminated.
Disability Insurance Q&A: How Should Doctors Approach Their Treating Physicians About a Disability Claim?
Question: How should doctors approach their treating physicians about a disability claim?
Answer: Your treating physician’s support can often be critical to getting your claim approved. A hurried, uninterested physician may not have time to devote to your claim. In addition, fully discussing your condition with a professional, compassionate treating physician will help ensure supportive medical records. When to discuss your potential claim with a physician is an important timing issue. Also, when the time comes to speak to the treating physician about the claim, a disabled dentist or doctor should ensure that the treating physician understands the definition of “disability” under the insurance policy, so that he or she can accurately opine as to the inability of the doctor or dentist to work.
Question: Why do many doctors’ disability claims get denied, and how can a law firm help?
Answer: Doctors’ and dentists’ disability claims can be expensive for insurance companies to accept. The troubled economy and the rising number of disability claims filed by healthcare professionals have led to financial hardship. This strain on resources creates an incentive for insurance companies to deny medical professionals’ claims. Thus, many insurers closely scrutinize the terms of doctors’ and dentists’ policies in order to find ways to deny disability insurance benefits, as the long-term financial benefit to the insurance company is significant.
Our firm has years of experience in cases in which disability benefits have been rescinded based on alleged misrepresentation or non-disclosure in the original policy application. We also have a strong history of prosecuting cases in which benefits have been denied based on the insurance company’s insistence that a dentist’s or doctor’s “subjective claim” doesn’t provide objective evidence of disability.
Further information on our law firm’s services and what you can expect when filing a disability claim is available on our website at this link.