Comitz | Beethe Attorney Ed Comitz Posts CE Course on Dentaltown

Ed Comitz’s Continuing Education course “Disability Insurance Roulette: Why is it So Hard to Collect on My Policy” is now available through Dentaltown.  This CE is an electronically delivered, self-instructional program and is designated for 2 hours of CE credit.  In this course, Ed discusses why it is so difficult for dentists to collect disability benefits and how to avoid the most common mistakes made by dentists when filing disability claims.  Ed also covers the key provisions to look for in disability insurance policies and provides an overview of the disability claims process.  Finally, the course discusses how disability insurance claims are investigated and administered, and identifies common strategies used by insurance companies to deny claims.

Information on how to register can be found here

For more information regarding what to look for in a policy, see this podcast interview where Ed Comitz discusses the importance of disability insurance with Dentaltown’s Howard Farran.

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Out of Contract Demands:
When You Can Tell Your Disability Insurer “No”

Every disability insurance policy is a contract. With this contract come certain rights and obligations on the part of the disability insurance company and on the part of the policyholder. The insurer promises to pay you disability benefits and you promise to fulfill certain conditions. One of the most important things to remember about this contractual relationship is that if it’s not in your policy, you don’t have to do it.

Often, disability insurers will ask a person filing for disability benefits to do certain things or provide certain information in order to qualify for benefits. What every policyholder needs to realize is that the disability insurer cannot force you to do something that is not outlined in your policy. There are many examples of disability insurance companies’ demands that may not be required under the terms of the policy, such as:

• That you see a certain type of doctor

• That you undergo surgery for your disabling condition

• That you get a particular treatment or therapy

• That you provide your Social Security or workers’ compensation claim file

• That you attend a certain type of examination

• That you complete detailed descriptions of your daily activities

• That you allow a private investigator into your home

The bottom line is that a policyholder filing for disability insurance benefits should know what their policy requires and what it doesn’t. The best way to be sure an insurer doesn’t get away with making extra-contractual demands is to have a disability insurance attorney review your policy and advocate with the company for your rights.

Will New Demands on Healthcare Professionals Lead to More Disabled Doctors?

A recent article by health insurance writer Allison Bell explains, from an insurance industry perspective, why the new administrative demands on health care professionals might lead to an increase in doctors facing disability:

[I]t seems reasonable to ask whether, for example, the new pressure to convert to electronic health records will lead to some physicians at small or understaffed practices to develop carpal tunnel syndrome and blurry vision from trying to enter, or at least, check, many of the records themselves. Will sleep deprivation related to an increase in workload cause or aggravate objective conditions, such as lack of exercise, obesity and high blood pressure, that will, in turn, lead to an increase in the number of doctors with disability insurance who suffer heart attacks. strokes and disabling car accidents?

Healthcare professionals: Do you think the push for electronic health records and the Patient Protection and Affordable Care Act will lead to an increase in disabled doctors?

Timing Is Everything: When to Discuss Your Potential Claim with a Physician

When it comes to disability insurance, your treating physician’s support can be critical to getting your legitimate disability claim approved. If your doctor can’t provide adequate documentation of your condition or is reluctant to get involved, there is a much higher chance that your claim will be denied. However, fully discussing your condition with a professional, compassionate treating physician will help ensure supportive medical records. When you are involved in a disability insurance claim, it is important to understand how to approach your treating doctor so that he or she can help you.

When to discuss your potential claim with a physician is an important timing issue. Instead of trying to enlist your doctor’s help at the very first visit, you should wait to talk to your treating physician until after he or she knows you and your condition well enough to opine accurately as to your ability to work. It is vital that you develop a relationship of trust and confidence with your doctor before inviting him or her to assist you in your claim. Physicians are often reluctant to support claims for disability insurance benefits if they question the motivations behind the claims. A physician who has treated, without success, the policyholder making a legitimate disability claim will be more willing to cooperate with the extensive process.

Making It Through the Holiday Season with a Chronic Disability

The holiday whirl of activity, as well as potential strain on the pocketbook and relationships, can be exhausting to even the healthiest amongst us.  For a person with a debilitating, chronic disability, it is important to communicate to those with whom you’ll be sharing the holidays what you realistically will be able to keep up with and participate in.

Social media blogger Toni Berhard has written an excellent article, available in full here, about some of the ways in which you can try to keep expectations realistic.  Ms. Berhard provides her insights into the myriad ways in which the holidays can be a stressful time for persons with disabilities.

…The holidays can be a recipe for double disaster—the increase in activity exacerbates your physical symptoms, while coping with sadness, frustration, and maybe even guilt about your physical limitations give rise to emotional pain.  No wonder many people with health problems dread the approaching holidays.

Ms. Berhard suggests the following:

  • Share information with friends and family members about your condition.  This can be particularly important if you have a disability that does not make you “look sick.”   Forward a few links or print out select pages and keep your accompanying note on the light side. She suggests, for example, that you could write that “there won’t be a test” in the note accompanying informational materials about your condition.
  • Write a letter.  Avoid being accusatory or whiny and simply express how difficult it has been for you to adjust to the changes your disability has caused in your life and how you wish you could be as active as you used to be.  Briefly describe your day-to-day life, unpredictability of your condition, and how much can realistically be expected from you during the holidays.
  • Enlist a close friend or family member as an ally.  This person can be supportive if you need to excuse yourself in the middle of a holiday gathering, and can also nudge you when they see that you are overdoing it.
  • Ultimately, you may have to accept that not all friends and family members will recognize your limitations.

As this year and holiday season draws near its end, we hope you have enjoyed a wonderful holiday, and we wish you all a very Happy New Year!

AzMedicine publishes “Can Your Disability Insurer Dictate the Terms of Your Care?” article by Ed Comitz and Michael Vincent

Disability insurance attorney Edward O. Comitz and Michael Vincent, Summer Associate at Comitz | Beethe, had their article Can Your Disability Insurer Dictate the Terms of Your Care? published in the Winter edition of AzMedicine, the publication of the Arizona Medical Association.  The article is excerpted below.

Can Your Disability Insurer Dictate the Terms of Your Care?

By Edward O. Comitz, Esq. and Michael Vincent

           Imagine that you are a surgeon who has submitted a disability insurance claim after failed cataract surgery left you with halos, starbursts, and even temporary blindness under bright lighting. While you are dedicated to your profession, you realize that continuing to operate on patients puts them in danger.  Your disability insurance company, however, will not pay your claim.  It insists that you can keep performing surgeries, alleviating any occupational hazards by wearing sunglasses and using matte-finish instruments in the operating room.  This scenario may sound absurd, but it is an actual example of some of the difficulties faced by many doctors seeking legitimate policy benefits.  Fortunately, the surgeon in question had the common sense to cease performing surgeries rather than follow her insurer’s suggestions.  Her decision did affect her financially, as benefits were denied for almost two years, and only paid after litigation ensued.

Insurance company treatment mandates are commonplace and based on their interpretation of the terms of your policy.  In some cases, the insurance company goes so far as to demand surgery, invading your privacy and leaving you with the choice of either undergoing an operation involuntarily, bearing all of the medical risks and financial costs yourself, or waiving your right to collect disability insurance benefits.  The decision can be difficult, but understanding your rights and obligations beforehand can help alleviate much of the worry.

Whether or not insurers can legally condition payment of your disability insurance benefits upon you following their suggested treatments depends on the specific terms in your policy.  The various policy types fall into three general categories: “regular care” policies, “appropriate care” policies, and “most appropriate care” policies.

The oldest policies typically contain provisions conditioning benefits on being “under the regular care and attendance of a physician.”  These “regular care” policies provide the most protection for insureds, as courts have repeatedly found that these provisions only create a duty for the insured to undergo regular monitoring by a physician to determine if the disability persists.  Even if a proposed surgery is usually successful and very low risk, an insurance company cannot force it upon you.  Under a policy requiring only regular care, courts will not enforce any particular course of treatment, no matter how vehemently an insurance company objects. Continue reading “AzMedicine publishes “Can Your Disability Insurer Dictate the Terms of Your Care?” article by Ed Comitz and Michael Vincent”

Guidelines for Reporting and Writing About People with Disabilities

Birth defect or congenital disability Fitconvulsion, or seizure?  Quadriplegicparaplegic, or person with a spinal cord injury?  Midgetdwarflittle person, or person of short stature?

The Research and Training Center on Independent Living at the University of Kansas publishes and updates a pamphlet called Guidelines for Reporting and Writing About Disabilities that is a helpful reference manual for understanding and using preferred and accurate terminology when writing on the subject of disabilities.

While there is not complete agreement on which terms are preferred, the booklet has been adopted into the Associated Press Stylebook, reflects the input of over 100 national disability organizations, and has been endorsed by the AIDS Action Council, National Down Syndrome Congress, Bazelon Center for Mental Health Law, Brain Injury Association of America, Post-Polio Health International, the National Council for Independent Living and many others.

In addition to specific terminology, the manual provides some general guidelines, including:

  • Do not focus on disability unless it is crucial to a story.  Avoid tear-jerking human interest stories . . . Focus instead on issues that affect the quality of life for those same individuals . . .People with disabilities actively participate in their communities and can participate even more when portrayed just like anyone else in the community.
  • Put people first, not their disability.  Say woman with arthritis, a child who has a learning disability, or person with a disability.  This puts the focus on the individual, not the particular functioning limitation.  Labeling the person as the disability (for example, a quad) dehumanizes the individual and equates the condition with the person.
  • Do not portray successful people with disabilities as heroic overachievers or long suffering saints.  Even though the public may find these portrayals inspirational, these stereotypes raise false expectations that all people—with and without disabilities—should be such “super humans.”
  • Avoid sensationalizing and negative labeling.  Saying afflicted withcrippled with, victim of, or suffers from devalues individuals with disabilities by portraying them as helpless objects of pity and charity.  It is more neutral to say an individual with AIDS than a person who suffers from AIDS.   Similarly, do not use emotional descriptors such as unfortunate or pitiful.
  • Emphasize abilities, not limitations.  For example, uses leg braces or walks with crutches is more accurate thanconfined to a wheelchair or wheelchair bound.
  • Bypass condescending euphemisms.  Disability groups strongly object to the use of euphemisms to describe disabilities.  Terms such as handicapable, differently abled, special, and challenged reinforce the idea that people cannot deal honestly with their disabilities.
  • Maintain the integrity of each individual.  Do not use words or phrases regarded as offensive.
  • Do not imply disease when discussing disabilities that result from a prior disease episode.  People who had polio and experienced after effects have post-polio syndrome.  They are not currently experiencing the disease.  Do not imply disease with people whose disability has resulted from anatomical or physiological damage…Reference to disease associated with disability is acceptable only with chronic diseases, such as arthritis, Parkinson’s disease, or multiple sclerosis.

TSA to Launch Disability Hotline
in January for Airline Passengers

In the wake of a number of complaints from passengers with disabilities, the Transportation Security Administration is planning to launch a toll free disability hotline in January so that passengers with disabilities can call in advance if they anticipate needing extra assistance during security screening.  In recent months, there have been numerous complaints, many from elderly women, alleging that TSA agents subjected them to strip searches because they were unfamiliar with the specialized medical devices the women were wearing.

Sen. Charles Schumer, D-N.Y. and New York State Senator Michael Gianaris made a request in a letter to U.S. Department of Homeland Security and TSA officials for passenger advocates to be trained and familiarized with various medical conditions and medical devices so that they can provide “alternative methods for addressing the needs and concerns of elderly, disabled and other vulnerable passengers.”

Senator Schumer further said:

While the safety and security of our flights must be a top priority, we need to make sure that flying does not become a fear-inducing, degrading and potentially humiliating experience.  Right now, passengers who feel that their rights are about to be violated have nowhere to turn, but by training passenger advocates at each of our airports, the TSA can finally give passengers a voice.

TSA has not commented on the proposal but issued a statement reminding the public that customer service representatives are available at most airports.   The TSA currently offers Tips for the Screening Process on its website as well as other more detailed information, and we will be reviewing some of the other regulations for passengers with disabilities in subsequent blog posts.

UPDATE:  The TSA Cares hotline designed to assist travelers with disabilities and medical conditions has now been launched.    It is recommended that those traveling with special medical needs contact the hotline at least 72 hours in advance of their arrival at the airport with questions about screening policies, procedures and to coordinate getting through the security checkpoints.   The TSA Cares toll-free hotline number is 1-855-787-2227, and its hours of operation are Monday through Friday 9:00 a.m. to 9:00 EST, excluding federal holidays.

Dealing with a New Disability

A recent article by Pamela Poole in the Huffington Post offers a sensitive look at the challenges faced when a person becomes disabled.  The adjustments to be made, both by the person with the disability and by his or her friends and family, extend beyond the physical.   Ms. Poole summarizes the first ten months of her own sudden disability thusly:

denial denial indignation fear anger anger denial

anger depression depression medication

Poole chronicles not only her own struggle to accept the changes her disability made in her life, but the obstacles she faced in making her friends and family understand the new limitations on her abilities and endurance.  Ms. Poole’s article and references to books and articles she found helpful are available at this link.

The physical and emotional impacts of a disability are difficult enough.  If your disability insurance company is giving you the runaround, it can be helpful to have an experienced disability insurance attorney advocating on your behalf and guiding you through the claim process.

Disability Insurance Law Firm Comitz | Beethe an Exhibitor at Arizona Osteopathic Medical Association’s
Fall Seminar in Tucson

Comitz | Beethe, disability insurance attorneys with offices in Scottsdale, Tucson and Flagstaff, are proud to be exhibitors at the Arizona Osteopathic Medical Association’s 31st Annual Fall Seminar this weekend, November 12 – 13, 2011, at the Omni Tucson National in Tucson, Arizona. Osteopaths attending the Fall Seminar should feel free to stop by our exhibitor table on Saturday, where we will have an attorney available to speak with you, as well as informative articles and handouts available regarding the challenges presented to physicians when filing a disability claim and mistakes to avoid.

Information about the firm and our other practice areas will also be available.  The exhibitor hall will be open before breakfast, with doors opening at 6:30 a.m. until noon.  Comitz | Beethe is a Business Affiliate of the Arizona Osteopathic Medical Association.   Further information about registering to attend the Fall Seminar is available at the AOMA’s website.  We hope to see you there!

The disability insurance attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Scottsdale, Tucson, Flagstaff, Sedona, Lake Havasu City, Prescott, and Yuma. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.

How to Get a Copy of Your Disability Insurance Policy

Many of the questions surrounding a disability insurance claim depend on the language in your policy.  Thus, the first step to a successful disability claim is getting a copy of that policy.  Though it is always important to keep a copy of your disability insurance policy and any related documents, sometimes policyholders forget to do so, they lose the document, or the papers become accidentally damaged.

The simplest way to get a copy of your policy is to call or send a letter to your insurance company directly.  You can search for your disability insurer’s phone number and address on the Arizona Department of Insurance website.  The insurer may require you to pay a minor fee, but they will send you a copy.

Once you receive your copy, check to make sure it is actually yours and that no pages are missing or damaged.  If you have questions about the provisions in the disability insurance policy or filing a claim for benefits, you can bring your copy to a disability insurance attorney who can help interpret it and guide you through the disability claims process.

What is a Reservation of Rights?

When a disability insurance company is fighting a claim, it will often agree to pay benefits – but with a “reservation of rights.” What is a reservation of rights and how can it impact a legitimate disability claim?

When an insurer pays a disability claim under a reservation of rights, it is essentially providing a provisional payment.  Though the insurance company may be sending you a check, it is not admitting that it actually has any liability under the policy.  Instead, it is “reserving the right” to stop paying your disability claim if it can find evidence to deny it later.  Once the company denies your disability claim, they can also demand you to repay them whatever proceeds they have distributed to you.

This practice is good for the insurance company, as it buys it extra time to investigate – and often later deny – a claim without putting it at risk of violating the laws against undue delay in payment.  However, because the insurance company can still investigate the claim and then demand full repayment at any moment, the reservation of rights provides no peace of mind for the policyholder.  Fortunately, a disability insurance attorney can protect you from this uncertainty by properly presenting your claim and thoroughly monitoring the insurance company’s actions to reach a beneficial result.

Surveillance of Disability Claimants: When Are Private Investigators Watching?

As we have discussed in the past, surveillance is a tool commonly used by disability insurance companies to analyze – and often deny – legitimate disability claims.  When surveillance is taken out of context or misconstrued, it can lead to unfair disability denials.

All too often, disability insurance companies expect people with disabilities to stay at home, in bed.  What they fail to realize is that most doctors actually encourage disabled claimants to try some activities of daily living, light physical therapy, or social interaction.  Just because a disabled person can eat chips at a restaurant with family doesn’t mean he can perform all of the duties of his former occupation.  Nevertheless, disability insurers often try to get any physical activity on camera and use it as proof that the claimant is not disabled.

Many people filing for private disability wonder when private investigators are watching them.  After years of dealing with disability insurance detectives, we have recognized the five most popular times for surveillance of policyholders:

  • During holidays. This is when policyholders are likely to be out of the house enjoying time with family and friends.
  • On the claimant’s birthday. Just as on holidays, a disabled claimant is likely to push themselves to get out and enjoy the day.
  • Over weekends. During weekends, insureds or more likely to attempt minor errands or go outside with family.
  • Any time they have a chance of catching  a claimant engaged in physical activitybased on information provided by the claimant on activity logs and in interviews. For example, if the claimant wrote on an activity log that he takes his dogs out in the morning, the private investigator will be there with a camera to document the insured walking in the yard.
  • Near the end of fiscal quarters, when the insurance company is under pressure to save money by denying or terminating claims.

Insurance Bad Faith: Different Standards for Different States – Part 7 (Washington)

A disability insurance company may be subject to a lawsuit for bad faith when it wrongly denies a claim.  There are differences from state to state in what constitutes insurer bad faith. In previous posts in this series, we outlined the standards of ArizonaCaliforniaColorado, NevadaNew Mexico, and Texas.  In today’s post, we outline the bad faith law of Washington.

Insurance companies who use unfair claim settlement practices can be found to have committed bad faith under Washington’s tort law or under the Washington Consumer Protection Act.  According to Washington law, an insurance company’s violation of the consumer protection statute constitutes an automatic unfair trade practice violation, and also a breach of the duty of good faith and fair dealing. If a policyholder brings a claim under the Consumer Protection Act, he or she will have to show economic (monetary) damages, but if he or she brings a tort bad faith claim, the injury need not be economic and can include emotional distress or other personal injuries.

The Statutes: R.C.W. 48.01.030 and Wash. Admin. Code § 284-30-330

The Rules: Washington regulations define the following as unfair or deceptive practices for settlement of insurance claims:

  • Misrepresenting pertinent facts or policy provisions.
  • Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies.
  • Refusing to pay claims without conducting a reasonable investigation.
  • Failing to affirm or deny coverage within a reasonable time after fully completed proof of loss documentation has been submitted.
  • Not attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear.
  • Compelling an individual disability claimant to initiate or submit to litigation, arbitration, or appraisal to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in such actions or proceedings.
  • Attempting to settle a claim for less than the amount to which a reasonable person would have believed he or she was entitled by reference to written or printed advertising material accompanying or made part of an application.
  • Asserting to a disability insurance claimant that the company has a policy of appealing arbitration awards in favor of insureds for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration.
  • Delaying the investigation or payment of claims by requiring a first party claimant or his or her physician to submit a preliminary claim report and then requiring subsequent submissions which contain substantially the same information.
  • Failing to promptly settle claims, where liability has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
  • Failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement.
  • Failing to expeditiously honor drafts given in settlement of claims.
  • Failing to adopt and implement reasonable standards for the processing and payment of claims after the obligation to pay has been established—normally within 15 business days after receipt by the insurer or its attorney of properly executed releases or other settlement documents.
  • Negotiating or settling a claim directly with any claimant known to be represented by an attorney without the attorney’s knowledge and consent.

The Tort Law Standard:  An insurance company’s actions can be considered bad faith if its breach of the insurance contract was unreasonable, frivolous, or unfounded.

Insurance Bad Faith: Different Standards for Different States – Part 6 (Texas)

The latest installment in our series of blog posts outlines the insurer bad faith law of Texas. Previous posts covered similar laws in Arizona, California, Colorado, Nevada, and New Mexico.

The Texas statutes and bad faith tort law are closely related. An insurance company’s bad faith gives rise to a violation of the Deceptive Trade Practices-Consumer Protection Act and Texas Insurance Code.  If an insurance company has not acted in bad faith, it cannot be liable under the statutes.  Ultimately, a private individual whose disability insurance claim was unfairly denied can bring an action against the insurance company under either the statute or the state tort law.

The Statute: Tex. Ins. Code Sec. 541.060

The Rules: It is considered by law to be an unfair or deceptive act or practice for an insurance company to engage in the following unfair settlement practices:

  • Misrepresenting a material fact or policy provision to the person making the claim.
  • Failing to bring about a fair, prompt, equitable settlement when the disability insurer’s responsibility to pay has become reasonably clear.
  • Failing to provide a claimant with a prompt and reasonable basis, grounded in the policy or the applicable law, or the denial of the claim or a settlement offer.
  • Failing to affirm or deny coverage or submit a reservation of rights.
  • Refusing a settlement offer on the basis that other coverage may be available, except as specifically provided in the claimant’s policy.
  • Refusing to pay a disability insurance claim without conducting a reasonable investigation.
  • Undertaking to enforce a full and final release of a claim from a policyholder when only a partial payment has been made, unless the payment is a compromise settlement of a doubtful or disputed claim.

The Standard:  A disability insurance company is liable for bad faith if it knew or should have known that it was reasonably clear that the claim was covered.  An insurance company cannot escape bad faith liability merely by failing to investigate a claim so that it can contend that its obligation to pay was never reasonably clear.