Are Insurance Companies Discriminating Against Mental Health Claims?
In previous posts, we have noted that disability policies often limit the disability benefits available for claimants who suffer from mental health disorders. For example, many policies limit recovery under a mental health disability claim to a 2 or 3 year period. In contrast, most disability insurance policies provide benefits for physical disability claims to age 65, and some policies even provide lifetime benefits for physical disability claims.
Recently, Representative Ruth Balser has introduced a bill in the Massachusetts state house that would prohibit insurance companies from treating behavioral health claims differently from physical impairment claims. According to Representative Balser, offering shorter benefit periods to claimants with mental health disorders is discrimination.
Supporters of the bill contend that the way that disability insurers currently handle mental health is based on stigmas and ignores available treatments options. Supporters of the bill also argue that the bill will reduce government costs because individuals with mental health issues will no longer need to rely on Social Security or government welfare programs.
The insurance industry’s response is that requiring insurance companies to provide more coverage will cost businesses money because it will limit available options when buying insurance and force them to buy coverage that they do not want. The insurance companies also argue that the bill will actually result more people relying on government programs because they will not be able to afford the increased levels of coverage.
At the moment, the bill is still being considered in committee, so it has not yet become law. However, if the bill is ultimately passed, it could significantly alter the way insurance companies treat mental health disability claims, particularly if other states pass similar laws.
For more information, see http://www.milforddailynews.com/article/20151016/NEWS/151017038.
Fibromyalgia: Part 2
In Part 1 of this post, we listed some of the symptoms and potential causes of fibromyalgia. In Part 2, we will discuss some proposed treatments for fibromyalgia.
Treatment
Unfortunately, while there are a variety of ways to treat fibromyalgia, there is currently no cure for fibromyalgia. Some of the most prominent courses of treatment include:
- Exercise: Many fibromyalgia patients may be afraid to exercise because they think it will increase their pain. However, being active may help to alleviate pain because physical activity can increase endorphin levels that patients may be lacking. Exercise can also alleviate stress, anxiety and depression—common symptoms of fibromyalgia.
- Physical Therapy: Some physical therapists utilize exercises that help fibromyalgia patients relax tense muscles and move in ways that will not exacerbate pain levels. Physical therapy is often used as a precursor to exercise.
- Medication: Antidepressants are often prescribed to help with the depression, fatigue, and sleep issues associated with fibromyalgia. Medications that facilitate restful sleep may also help with the pain, by allowing patients the rest needed to recover. Other drugs, such as Lyrica, have been approved by the FDA to directly treat fibromyalgia pain. Remember, you should always consult with your doctor before taking any medication.
Conclusion
Fibromyalgia is a condition that varies from person to person, with people having both good and bad days. If you suffer from fibromyalgia, note what makes your pain worse or better, and try to avoid or continue those practices. As always, it is important to consult with your doctor to ensure that you are receiving appropriate treatment for the chronic pain caused by fibromyalgia.
If your fibromyalgia has progressed to the point where you can no longer practice, we encourage you to contact an experienced disability attorney before filing a disability claim. Disability claims involving fibromyalgia can be particularly difficult, due to the subjective nature of the condition, so it is important to have an experienced advocate at your side to help you navigate the claims process.
Fibromyalgia: Part 1
In this post, we are going to take a look at some of the symptoms and causes of a debilitating condition known as fibromyalgia.
Symptoms
Fibromyalgia is a syndrome that is characterized by chronic, widespread muscle pain. Other symptoms include:
- Fatigue;
- Trouble sleeping;
- Morning stiffness;
- Muscle knots, cramping, or weakness;
- Painful trigger points;
- Dry eyes;
- Concentration and memory problems, called “fibro fog”;
- Irritable bowel syndrome;
- Anxiety or depression; and
- Headaches.
Fibromyalgia is difficult to diagnose, because most of the symptoms are relative or subjective. Notably, certain forms of arthritis may cause similar symptoms. However, persons with arthritis suffer from pain that is localized in joints. In contrast, persons with fibromyalgia suffer pain that is primarily felt in muscles, tendons, and ligaments.
Potential Causes
Because fibromyalgia is difficult to diagnose (due to the subjective nature of its symptoms), there is no clear consensus as to the causes of fibromyalgia. Here are some of the theories that researchers have suggested:
Lower Levels of Serotonin and Endorphins
Serotonin is a neurotransmitter that is associated with calming and feelings of well-being and happiness. Endorphins are also associated with happiness and serve as painkillers. If someone has lower levels of serotonin and endorphins, they may be more susceptible to feeling pain, or may feel pain more intensely than someone with normal serotonin and endorphin levels.
Stress
Some researchers theorize that stress causes muscle “microtraumas,” which in turn leads to a cycle of pain and fatigue caused by an inability to rest due to the pain.
Gender and Biological Changes
Statistically speaking, women seem to be at greater risk for fibromyalgia. For this reason, some scientists have proposed that fibromyalgia pain may be connected to hormonal changes such as menopause.
Heredity/Genes
Fibromyalgia could be due to a genetic tendency that is passed down and regulates the way one’s body processes pain. Although, as of yet, no particular “fibromyalgia gene” has been identified, several genes have been found to occur more often in people with fibromyalgia.
Trauma
Accidents, injury, and illness involving the brain or spinal cord may contribute to fibromyalgia pain. Such trauma may alter the way neurotransmitters, such as serotonin, are produced, or it may lower an individual’s emotional threshold for pain.
Should Women Pay More for Disability Insurance?
Massachusetts is currently considering a bill that would prohibit disability insurers from charging higher rates to women than to men. Even if a woman is the same age, has the same job, and has the same health history as a man, she pays on average 25% more for the same protection, according to Massachusetts State Representative Ruth Balser.
This bill would prohibit discrimination in premium costs or benefits based on sex in individual disability, accident, or sickness insurance policies. It would also bar disability insurers from making any distinction in insurance policies based on conditions unique to one’s sex, such as pregnancy.
The disability insurance companies, on the other hand, say that the difference is necessary, due to the fact that women account for 70-80% of long-term claims nationwide. While they do purchase more disability insurance policies than men (60% as compared to 40%), insurers argue that this isn’t enough to make up the difference in revenue. Insurers are in the business of making money, and paying out more in disability benefits than the amount of premiums coming in isn’t good for business.
According to the Affordable Care Act, health insurers can’t charge a woman more solely because she is a woman. Yet, Montana is the only state with a law requiring disability insurance to be gender neutral, and Massachusetts has a bill in the works. It remains to be seen whether Massachusetts will pass this bill, and other states will follow suit. With some of the major disability insurance carriers (such as Unum and Guardian/Berkshire) keeping corporate offices in Massachusetts, we doubt the bill will be passed without a fight.
What’s your opinion? Should women pay more in disability premiums than men with the same characteristics? Are the disability insurance companies’ arguments in favor of the disparity justified?
Essential Tremors (ET): Part 2
In Part 1 of this post, we looked at the risk factors, symptoms, and treatment options associated with ET. In Part 2, we will discuss how having an essential tremor could potentially affect your total disability claim.
How do I file for total disability when I have ET?
For those with an “Own Occupation” policy, which means you are considered totally disabled if you can no longer work in your own profession, having ET would certainly qualify you for disability benefits if you are a medical professional.
Many physicians think that they can simply decrease the types of procedures they perform or amount of time spent at working as their ET becomes more disabling, but this is the wrong move to make. Changing your work responsibilities can alter your “occupation” under the terms of your disability policy. For example, if you forego performing medical procedures and merely manage your practice, the insurance company may claim that your occupation has changed from a physician to an office manager, and attempt to decrease or deny your disability benefits. Similarly, if you start to work part-time instead of full-time, and then file for disability, an insurance company will likely classify you as a part-time worker, and thus only give you part-time benefits.
Other physicians may decide to continue working in spite of their ET. This is also a mistake. Trying to work when you have ET places your patients at risk. If a patient did get injured and filed suit, his or her attorney would almost certainly assert that you should not have been working with patients and that you knew your ET could harm the patient.
The correct way to deal with insurance companies and your condition is to stop working as soon as it impinges on your ability to perform your occupation and file for disability insurance. Since, in many cases, the onset of ET is gradual, it is important to discuss you symptoms with your doctor so he or she can determine when your condition will progress to the point that it affects your work.
Conclusion
ET is a condition that can have an effect on actions as small as carrying a water glass or tying your shoes. It can also affect your occupation and the financial security that comes from having total disability insurance. We encourage you to speak with your doctor if you think you may be at risk for or have ET, and to contact a disability insurance attorney to help with the claims process if you are planning on filing for disability benefits.
Essential Tremors (ET): Part 1
We’ve done a profile on how Parkinson’s disease can affect physicians and dentists, but did you know that essential tremors are eight times more common than Parkinson’s disease? A hand tremor is one of the last things a physician or dentist wants. Not only can it affect daily life, but working with patients safely becomes increasingly difficult.
In this post, we will list some of the risk factors and common symptoms associated with essential tremors and take a look at what can be done to perhaps alleviate symptoms.
What is an essential tremor and what are the symptoms?
An essential tremor (ET) is a neurological disorder that causes rhythmic shaking of part of the body—most often the hands, head, or voice.
The primary symptoms of ET are involuntary shaking, voice fluctuations, nodding head, balance problems, and tremors that get worse during periods of emotional stress, fatigue, caffeine use, and/or purposeful movement. ET is a progressive disorder than can become worse over time.
What is the difference between Parkinson’s and ET?
Many people believe that Parkinson’s and ET are the same thing. However, there are some subtle differences between the two conditions, including:
- Timing: ET usually occurs when you are in motion, while Parkinson’s is most noticeable when you are at rest.
- Related Conditions: ET generally does not cause other health problems, but Parkinson’s has been connected to poor posture, a shuffling gait, and slow movement.
- Parts of Body Affected: ET is most common in the hands, head, and voice. Parkinson’s most often starts in your hands and may also affect the legs and chin.
What are the causes and how do you know if you are at risk?
ET appears to be a genetic disorder, because approximately 50% of people with ET have a particular genetic mutation. However, scientists are not sure what causes ET in people who do not have the genetic mutation. Researchers have found that changes in specific areas of the brain may contribute to development of the condition, but such studies are inconclusive.
Because the other causes of ET are unknown, the primary way to determine whether you have a high risk of developing essential tremors is to check your family history. Due to the fact that the mutation is an autosomal dominant disorder, if one of your parents has ET, you have a 50% chance of developing the disorder. Another risk factor is age—people over 40 are more likely to have an ET.
Is there a cure for ET or a way to prevent it?
Unfortunately, is currently not a cure for ET. However, now that scientists have found a genetic link, further research could potentially discover ways to prevent ET.
How can I alleviate my symptoms?
Since emotional stress is one of the things that can aggravate ET, look for ways to relieve your stress. Other methods of alleviating ET include decreasing your coffee and caffeine intake and making sure that you get an adequate amount of sleep each night. Certain medications may also can help with ET, although it is important to speak with your doctor before starting any sort of treatment. Finally, surgery may be an option in some cases, although surgery certainly is not without its risks. Surgery for ET generally involves the implantation of a DBS, or a Deep Brain Stimulator. The DBS is a small device that delivers targeted electrical stimulation to the brain in an effort to reduce the frequency of tremors.
In addition to the foregoing methods of alleviating ET symptoms, there are other things that you can do to make living with ET easier, such as using a travel mug or straw for drinks, using heavier utensils for eating, wearing clothes that don’t have difficult buttons or laces, and saving your most difficult tasks for days when your tremor is least pronounced.
Disability Insurance Profiles: Principal Life
We are expanding our list of insurance company profiles that specifically market to dentists and doctors to include Principal Life.
See our other profiles of Great-West, MassMutual, MetLife, Northwestern Mutual, Guardian, Hartford, and Standard.
Principal Life (also known as “Principal Financial Group”) was founded in 1879. Initially, Principal Life operated primarily as an insurance company. Principal Life is now a member of the Fortune 500, and offers several additional services, such as retirement and asset management. Principal has most recently realized a growth in net income from $1.112 billion in June of 2014 to $1.290 billion in June of 2015.
Company: Principal Financial Group or The Principal.
Location: Des Moines, Iowa.
Associated Entities: Principal Financial Services, Inc.; Principal Life Insurance Company; Principal Real Estate Investors, LLC; Spectrum Asset Management, Inc.; Post Advisory Group, LLC; Columbus Circle Investors; Edge Management, Inc.; Morley Financial Services Inc.; Finisterre Capital, LLP.
Assets: $530.3 billion.
Notable Policy Features:
Principal Life sells polices that define “disability” as “own occupation”, which means that you are considered totally disabled if you are unable to perform the duties of your occupation. While this may seem like the right policy for a medical professional, you should be aware of a couple caveats. Coverage under a Principal Life policy is, in part, based upon a key definition that is usually referred to as your “occupation period.” Essentially, your “occupation period” is the time frame during which the “own occupation” definition of totally disabled applied. Once the “occupation period” has expired, Principal Life will only pay you benefits if you are unable to work in any occupation that you are reasonably suited to work in, based on your education, training, and experience.
The length of your “occupation period” can range from a base of 2 years after your disability to a period of 5 years, until age 65, until age 67, or until age 70, depending on your “occupation class.” Oftentimes, the policy provisions regarding “occupation periods” can be convoluted and difficult to decipher. If you unsure about the length of your “occupation period” under the terms of the policy, an experienced disability insurance attorney can help you understand the applicable policy language.
Claims Management Approach:
In comparison with other insurance companies, Principal Life generally conducts more in-person field interviews with claimants. Principal Life will not only conduct a field interview when you initially file your claim, but will also likely conduct several additional follow up interviews throughout the claims process.
Most insurance companies require you to fill out generic questionnaires that ask for information about the nature of your disability, among other things. Because Principal Life handles a lot of disability claims by physicians, it has created a particular “Medical Professional Occupation and Financial Questionnaire” that is more comprehensive than a generic questionnaire, and is specifically tailored towards collecting information from medical professionals. The questionnaire is quite extensive, and asks about a wide variety of information, from your ownership interest in your practice, to whether your practice participates in a health care network, to the credentials of the medical professional owners and associate professionals you work with, to whether you receive any reimbursements from prescriptions. If you are unsure about the content or scope of any questionnaire you receive, an experienced disability insurance attorney can help answer any questions you may have.
Are Longer Hours Hindering Your Ability to Work?
Long hours at work are typical of doctors: there is no break in people getting sick or having physical issues. But what does working long hours do physically and mentally to doctors, and how can this affect your practice? The term “overwork” refers to the increasing risk that a worker will experience symptoms of fatigue and work stress, which can undermine productivity rates. We’re going to be taking a look at some of the statistics involved with professionals working long hours and then discuss how this can not only hinder productivity in your practice, but can also affect your body and, in some cases, how soon you need to file a disability insurance claim.
Longer Hours
There numbers regarding the average work week for Americans, especially professionals such as doctors, show that most people expect to work extended hours. This is associated with the trend of “presenteeism” among doctors and dentists, which we have spent some time dissecting. In fact, many professionals now view the traditional 40-hour work week as a “part-time” job, and state that working those hours show laziness or a lack of desire to get ahead.
- In 2006, American families worked an average of 11 hours more per week than they did in 1979.
- 85.8% of males and 66.5% of women are working 40 or more hours per week. ((See American Average Work Hours at 20Something Finance))
- 37.9% of professional men worked over 50 hours a week between 2006 and 2008, which is an increase from 34%.
- The number of professional women working over 50 hours increased even more drastically, from 6.1% to 14.4% in the same time period. ((See Top-Level Professionals View 40-Hour Work Week as Part-Time at The Huffington Post))
- 52% of top income earners in America report working “extreme jobs,” which are those that require more than 60 hours a week. ((See Success Comes at a Steeper Price at ABC News))
Effects of Overwork ((See The Effects of Working Time on Productivity and Firm Performance))
Studies have shown that working longer hours leads to a decrease in productivity per hour. Any doctor that has worked more than 10 hours a day, as they often do, can attest that the 9th hour is much more difficult to get through than the first. The evidence shows that longer working hours have a negative effect on worker health due to fatigue and work stress, all of which further decrease labor productivity.
Workers with long hours are at a greater risk of health issues. For instance, those who perform repetitive tasks have an even greater chance of cumulative trauma disorder, such as carpal tunnel syndrome. This shouldn’t be shocking to medical professionals, as many of the disabilities that they suffer come from repetitive use injuries. An interesting way to think of the way your hours affect your work is to think of your body using a minimum amount of energy for posture and immunity, which has a great effect on back and neck pain. If you draw too much on this energy for work, your posture and immunity will suffer.
As another example, working extended hours can have a negative effect on mental health. We have also discussed how medical professionals are more susceptible to mental illness. Studies have shown that working long hours leads to increased stress, which can contribute to the already stressful situations doctors face every day.
What Does This Mean for You?
One positive finding regarding hours worked and productivity is that those who have the flexibility to schedule their own hours are not only happier but more productive. Even more striking is the fact that even if workers had to put in overtime, if they chose this overtime themselves instead of being asked to do it by a supervisor, they were much more productive and less fatigued.
This is certainly good news for those medical professionals that own their own business and are able to schedule their time as they see fit. However, doctors such as residents or those working within another professional’s practice may feel pressured to take on more hours, and are also constrained by other doctors’ schedules. For these reasons, it’s important for the medical and dental community as a whole to take a better approach regarding long hours. While we certainly don’t presume to know what is most appropriate in terms of streamlining care and administration, it certainly seems logical that doctors be encouraged to work fewer hours or have more freedom in scheduling the hours that they are going to work.
Let us know what you think about working long hours and whether you have schedule flexibility in the comments!
Could Your Tech Be Hurting You? : Skype Doctors
The third and final post of our series on insurance claims technology focuses on the recent development of digital healthcare. Our previous topics included Facebook and insurance company apps, and we analyzed how they can have a greater effect on your claim than you would think. You are now able to obtain a diagnosis and medication prescriptions via Skype. Just like the Hartford app, this is looking to streamline administrative processes and save people time. However, it is controversial in that many doctors believe that there are cases in which a physical examination is necessary, and webcam quality may not be enough to correctly diagnose a patient.
Diagnoses via Skype
It is touted as being quick and efficient; users need only to type in their symptoms and payment information and they will be connected with a doctor who can then call in a prescription as they see fit. While this is very convenient for people who are too busy or in too much pain to travel to and wait in a doctor’s office, it could also lead to a wrong diagnosis, which would almost assuredly use more time and money.
While there haven’t been any studies on how effective this form of treatment is, we advise disability insurance claimants to exercise caution when using these Skype calls. Because this technology is so new, there is little information on how disability insurance would approach Skype consultations in conjunction with a disability insurance claim. An insurance company could potentially say that this information is unreliable, and use the alleged lack of reliable medical evidence to deny your claim. If you are facing a disability insurance claim, speak with an attorney experienced in the area before you use a Skype consultation as evidence of your condition.
Conclusion
While it is certainly helpful that many things are now available at our fingertips through the development of new technologies, it is important to keep in mind that giving more information than necessary to insurance companies may hurt your claim. Most people who file disability claims have nothing to hide, but it is the insurer’s job to make money, and paying every claim isn’t a good way to do this.
Did we miss any new technology? Let us know in the comments!
Do You Need Disability Insurance for More than Just Yourself?
We spend a lot of time talking about disability insurance claims and mostly focus on the big one: personal disability insurance. However, there are three other types of insurance that you may not have been aware of, and could be potentially helpful to you and your practice. Today, we’ll be taking a look at key-person disability insurance, buyout disability insurance, disability insurance for overhead, and, of course, personal disability insurance.
Personal Disability Insurance
Essentially, disability insurance is insurance that you buy for yourself in the event that you become disabled while working. If you work in a profession where disability is a possibility, it is important to have personal disability insurance for the sake of your future. For instance, dentists are at higher risk for disability due to repetitive movements and static positions, so it is crucial for them to have a disability policy.
Further, we recommend that you purchase an individual disability insurance policy for yourself, and not through an employer-sponsored program. This makes sure that the policy is not covered by ERISA in the event that you do have to file a disability claim.
Key-Person Disability Insurance
Key-person disability insurance is a type of coverage for those that own their own business or practice. This form of insurance covers an employee that is “key” to your business: someone who would be impossible to replace due to their skill, customer base, knowledge or burden of responsibility. If this person was to become disabled, and you had key-person disability insurance, the business would receive disability income checks. These checks could be used to cover the financial loss of the missing employee, or it could pay for a temporary worker while the insured person recovers from the disability.
There are several things to consider when determining if you should buy key-person disability insurance. These include the contingencies for the company if a key employee is disabled, the time to find and train a suitable replacement, the amount of revenue directly attributable to the key person, whether or not the key person’s disability will result in the loss of clients, and whether your company is willing to self-insure.
Unlike personal disability insurance policies, key-person policies are limited in their features and options. Often, they are custom designed for the company so that they meet specific needs, and are also often very short term, lasting between 12–24 months. This is because it is usually assumed that you could find and train a replacement in that time span.
Continue reading “Do You Need Disability Insurance for More than Just Yourself?”
Disability Insurer Profiles: Great-West
Great-West Life & Annuity Insurance Company (“Great-West”) is the final disability insurance provider we will look at in our series profiling insurance companies that specifically market to physicians and dentists.
See our profiles of MassMutual, MetLife, Northwestern Mutual, Guardian, Hartford, and Standard.
Great-West, which also goes by the registered mark of “Great-West Financial,” was incorporated in 1907, and traces its roots to a Canadian parent company that was incorporated in 1891. Due to the nature of the economy and other factors, many insurance companies have suffered substantial losses in the past few years, and Great-West is no exception. Great-West’s net income recently dropped from 238.1 million in 2012 to 128.7 million in 2013. Consequently, Great-West may be looking to substantially increase its profits by, for example, denying high paying disability claims.
Company: Great-West Life & Annuity Insurance Company.
Location: Greenwood Village, Colorado.
Associated Entities: Great-West Lifeco Inc.; Great-West Lifeco U.S. Inc.; Great-West Life Assurance Company; Great-West Life & Annuity Insurance Company of New York; Great-West Capital Management, LLC; Great-West Funds, Inc.; GWFS Equities, Inc.
Assets: $55.3 billion in 2013.
Notable Policy Features: Great-West is the insurance company that provides group disability insurance for the American Dental Association (ADA), so if you have a Great-West policy, your claim will probably be governed by the terms of the ADA’s group disability policy.
Great-West frequently sends out notices of updates and changes to the underlying contract between the ADA and Great-West, so there is a chance that you may end up with insurance coverage that you did not bargain for at the point of sale. Oftentimes these notices are full of legalese and insurance jargon, and may be difficult to understand. Nevertheless, it is important for you to promptly review any notices you receive, because they may impact your disability coverage in significant ways. If you receive such a notice and are unsure about what it means, an experienced disability insurance attorney can explain how the changes outlined in the notice will impact your policy.
Additionally, if you have a Great-West policy, you should be aware that your policy may contain a very strict provision requiring you to obtain proper medical care for your condition. For this reason, if you are thinking about filing a disability claim with Great-West, you should make sure that your medical treatment is both well-documented and “appropriate” under the policy’s terms.
Claims Management Approach: How Great-West administers your disability claim will depend on the terms of the policy at the time you file your claim. Because the terms of the ADA’s group disability policy are renegotiated on a regular basis, the terms of your disability policy will likely change over time. Since your initial copy of the policy may no longer be accurate by the time you file your disability claim with Great-West, be sure to ask for a copy of the current version of your policy so that you know your rights under your disability insurance policy.
These profiles are based on our opinions and experience. Additional source(s): Great-West Financial’s 2013 Annual Report; www.greatwest.com.
Disability Insurer Profiles: Standard
Standard is another disability insurer we will look at that specifically markets its policies to physicians and dentists.
See our profiles of MassMutual, MetLife, Northwestern Mutual, Guardian, and Hartford.
StanCorp Financial Group (“StanCorp”) was founded in 1906 and uses the marketing name “The Standard” to refer to its primary subsidiaries, which include the Standard Insurance Company and the Standard Life Insurance Company of New York. In 2013, StanCorp received $351.7 million in pre-tax income, and $272.4 million (approximately 77%) of that income was attributable to profits from StanCorp’s insurance services. StanCorp is particularly proud of its consistent long term growth and—given the fact that 77% of StanCorp’s profits come from its insurance services—StanCorp has an obvious incentive to deny high paying disability claims submitted by physicians and dentists.
Company: StanCorp Financial Group, Inc.
Location: Portland, Oregon.
Associated Entities: Standard Insurance Company; The Standard Life Insurance Company of New York; StanCorp Investment Advisers, Inc.; Standard Retirement Services, Inc.; StanCorp Mortgage Investors, LLC.
Assets: $22.73 billion in 2014.
Notable Policy Features: If you are considering a Standard disability insurance policy, you should pay particular attention to whether the policy allows for total disability benefits if you are working in another occupation. Oftentimes, Standard policies will pay nothing more than residual disability benefits if you are able to secure other part-time employment. For example, if you can no longer practice dentistry, but you are able to teach classes at a dental college, Standard may refuse to pay you total disability benefits. If you are eligible for residual benefits, Standard will require you to submit proof of your income every single month.
Read more about the difference between total disability benefits and residual disability benefits.
Claims Management Approach: Standard tends to demand strict compliance with its claims procedures, and Standard will generally not be very accommodating if you make a mistake. This can be problematic, because, for many policyholders, the disability claims process is unfamiliar and daunting. If you are dealing with Standard, be sure to ask for a detailed explanation of what is required of you. You should pay close attention to deadlines, as they will likely not be flexible. You should also make sure that you use Standard’s forms when providing attending physician statements or other documentation of your disability, because Standard will not accept other insurers’ forms.
These profiles are based on our opinions and experience. Additional source(s): “Quick Facts About the Standard” and “About the Standard,” available at www.standard.com; StanCorp 2014 KBW Conference Presentation, available at investor.stancorpfinancial.com.
Disability Insurer Profiles: Hartford
Hartford is the next disability insurer we will look at that specifically markets its disability policies to physicians and dentists.
See our profiles of MassMutual, MetLife, Northwestern Mutual, and Guardian.
The Hartford Financial Services Group, Inc. (“Hartford”) was founded over 200 years ago and now has more than 100 offices located throughout the U.S. In 2013, Hartford’s revenues were approximately $26.2 billion. However, in 2014, Hartford’s revenues dropped to $18.6 billion. Given this significant decrease in revenue, Hartford will likely go to great lengths to avoid paying high paying claims submitted by physicians and dentists, and may even attempt to revoke disability benefits that it approved before the company experienced this dramatic drop in profits.
Company: The Hartford Financial Services Group, Inc.
Location: Hartford, Connecticut.
Associated Entities: Hartford Fire Insurance Company; Hartford Life, Inc.; Hartford Accident and Indemnity Company; Hartford Casualty Insurance Company; Hartford Life and Accident Insurance Company; Hartford Life and Annuity Insurance Company; Hartford Life Insurance Company; Property and Casualty Insurance Company of Hartford.
Assets: $245 billion in 2014.
Notable Policy Features: Hartford offers disability insurance policies that define total disability as being unable to perform one of your prior substantial and material duties. If your disability policy contains such a definition, it will be much easier for you to demonstrate that you are totally disabled. In contrast, if your disability policy does not define total disability in this manner, you may have to prove that you cannot perform any of your prior substantial and material duties in order to receive total disability benefits.
Claims Management Approach: Hartford only offers group disability policies (as opposed to individual disability policies). This means that if you have a Hartford policy, it will probably be governed by ERISA. For many reasons, it will likely be harder for you to obtain your disability benefits if your policy is governed by ERISA.
For example, normally, if you become disabled and you have an individual disability policy, you can collect your disability benefits without filing for Social Security. However, if you have a Hartford group policy, your policy may require you to apply for Social Security benefits before you can receive your disability benefits. Hartford requires its policyholders to apply for Social Security because, under ERISA, any Social Security benefits the policyholder receives automatically offset the amount of disability benefits Hartford must pay the policyholder.
Read more about how ERISA claims are treated differently than non-ERISA claims.
These profiles are based on our opinions and experience. Additional source(s): Hartford’s 2014 Annual Report; “The Hartford Fact Sheet (2013),” and “The Hartford Fact Sheet (2014),” available at www.thehartford.com.
Disability Insurer Profiles: Guardian
In the last few posts, we’ve looked at a few of the most common disability insurance companies for doctors. See our profiles of MassMutual, MetLife, and Northwestern Mutual. Guardian is another disability insurer that specifically markets its disability policies to physicians and dentists.
Guardian has been around for over 150 years and is one of the largest individual disability income insurance providers in the United States. Guardian’s business model emphasizes the need for continuous growth, and Guardian reports that it has paid out dividends to its owners every year since 1868. To reach its goal of uninterrupted growth and live up to its owners’ expectations that it will pay out dividends each year, Guardian must not only maintain its past levels of profitability, but also come up with new ways to be more profitable. Obviously, from Guardians’ perspective, denying high paying disability claims submitted by physicians and dentists is an attractive method of increasing its profits.
Company: The Guardian Life Insurance Company of America.
Location: New York, New York.
Associated Entities: The Guardian Insurance & Annuity Company, Inc.; Berkshire Life Insurance Company of America; Guardian Investor Services, LLC; Park Avenue Securities LLC; RS Investment Management Co. LLC; Reed Group, Ltd.
Assets: $84.1 billion in 2013.
Notable Policy Features: Guardian policies oftentimes attach a “Residual Disability Rider” to their disability policies. This rider could impact you in significant ways if you are partially disabled and considering part-time work. For instance, the residual disability rider to your policy might contain the following provisions:
“Income. Income means your gross earned income, less business expenses, but before any other deductions. It includes salaries, wages, fees, commissions, bonuses, business profits or other payments for your personal services.”
“Prior Income. Prior income means your average monthly income for the tax year with the highest earning in the three years just prior to the date on which you became disabled.”
“Current Income. Current income means all income which you receive on a cash basis in each month while you are residually disabled.”
“Loss of Income. Loss of income means the difference between your prior income and your current income.”
“Residual Indemnity. Residual indemnity = (loss of income/prior income) x monthly indemnity.”
“Termination of Residual Indemnity. Residual indemnity will stop when the first of the following events occurs:
- you become totally disabled; or
- the benefit period ends; or
- your loss of income is less than 20% of prior income . . . .”
When read together, these provisions essentially mean that if you are partially disabled and working in another occupation, Guardian includes the additional income earned in that occupation when determining your current monthly income. This is important because you could lose your residual disability benefits if, after adding in your additional income, your loss of income amounts to less than 20% of your prior income. If you have this residual rider in your disability insurance policy, you should be aware that accepting part time work could jeopardize your ability to collect residual disability benefits.
Read more about residual disability benefits.
Claims Management Approach: Like many of the other insurance companies we have profiled, Guardian frequently conducts in-home field interviews, in an effort to catch you off guard and observe you in a state of activity that may not accurately reflect the severity of your condition. In-home field interviews also allow Guardian to collect personal information, such as your daily routine, hobbies and interests, names of friends and family, and work hours, so that its private investigators can more easily conduct surveillance of you.
If your disability claim involves a psychological disability, Guardian will likely require you to submit proof that you are being treated by a PhD level therapist, even if you have been working with a non-PhD level therapist for a significant period of time. Consequently, if you have a Guardian disability insurance policy and are in need of therapy, you might want to consider consulting with a PhD level therapist from the start.
A final tactic frequently used by Guardian is the peer-to-peer call, which consists of Guardian directly contacting your treatment providers over the phone without your consent. This tactic is similar to the in-home field interview in the sense that it is an attempt to catch your treating physicians off-guard by ambushing them with detailed questions about your disability. Since these discussions take place over the phone, your treating physicians will likely not have an opportunity to provide well thought out, thorough answers, and there will likely be little, if any, documentation of the call. Although this tactic is alarming, it is easily countered. As we explained in a previous post, peer-to-peer calls can be preempted in most cases if you have your disability insurance attorney notify the insurance company that all communications with your treatment providers must be coordinated through your attorney’s office.
These profiles are based on our opinions and experience. Additional source(s): Guardian’s 2013 Annual Report; Guardian Fact Sheet 2013; guardianlife.com.
Disability Buyout Policies
Have you ever wondered about disability buyout insurance for doctors and dentists?
Attorney Patrick T. Stanley gives a comprehensive overview of these policies on Comitz Stanley’s healthcare transactions and litigation blog.
Check it out and contact Mr. Stanley with your questions: Disability Buyout Insurance–Protecting Yourself and Your Partners.
Disability Insurer Profiles: Northwestern Mutual
In this series, we’re taking a look at some of the most popular disability insurance companies for doctors. See our profiles of MassMutual and MetLife. Northwestern Mutual is another disability insurer that specifically markets its disability policies to physicians and dentists.
In 2014, the company insured 476,000 people through 727,000 individual disability policies. Northwestern Mutual prides itself on paying more dividends that its competitors. In order to do that, of course, it must maintain consistently high profit levels.
Company: Northwestern Mutual Life Insurance Company.
Location: Milwaukee, Wisconsin.
Associated Entities: Northwestern Long Term Care Insurance Co., Northwestern Mutual Investment Services, LLC, Northwestern Mutual Wealth Management Co., The Frank Russell Co.
Assets: $217.1 billion in 2014.
Notable Policy Features: Northwestern Mutual sells policies with an “own occupation” definition of total disability. However, these disability insurance policies are often only truly “own occupation” for a limited amount of time, after which they become any occupation policies (only providing benefits if you are unable to work in any job) or “no work” own occupation policies (only providing benefits if you are unable to perform your job duties and are not working in another job).
For instance, a Northwestern Mutual policy might include the following definition:
Total Disability. Until the end of the Initial Period [defined elsewhere as 60 months of benefits], the Insured is totally disabled when is unable to perform the principal duties of his occupation. After the Initial Period [i.e., 60 months], the Insured is totally disabled when he is unable to perform the principal duties of his occupation and is not gainfully employed in any occupation.
In order to make sure a Northwestern Mutual disability insurance policy keeps the own occupation definition for as long as you hold the policy, you may need to purchase an additional benefit rider.
Read more about Northwestern Mutual’s interpretation of its own occupation policies.
Claims Management Approach: Some of the claims strategies that Northwestern Mutual is known to use include conducting in-home field interviews on top of third-party surveillance, hiring its own medical consultants to review claimants’ records and opine on whether or not they are disabled, and demanding that claimants (especially those with mental conditions) undergo “independent” medical examinations (IMEs) with providers of Northwestern Mutual’s choosing.
These profiles are based on our opinions and experience. Additional source(s): Northwestern Mutual’s 2013 Annual Report; Northwestern Mutual Fact Sheet 2014; Forbes.com.
What to Do When Your
Disability Insurance Claim Is Denied
A large part of our practice consists of helping physicians and dentists whose disability insurance claims have been denied or terminated. When our clients come to us, we carefully analyze their medical records, the claim file, and the law to craft a specific strategy for getting the disability insurer to reverse its adverse determination. Unfortunately, we sometimes find that in between receiving notice that their claim has been denied or terminated and getting in touch with our firm, doctors will inadvertently take actions that prejudice their disability claims. With that in mind, it’s important to review what to do and what not to do in the first few days after your claim is denied or terminated.
- In all likelihood, you will first find out that your insurer is denying or ending your disability benefits via a telephone call from the claims consultant who analyzed your claim. As we’ve explained before, the consultant will be taking detailed notes about anything you say during that call. Therefore, even if you are justifiably upset or angry, be very mindful of what you say. Anything you tell the consultant will certainly be written down and saved in your file.
- During the call with your consultant, make your own notes. You don’t have to ask a lot of questions at this stage, but you do want to make sure to record whatever information the consultant gives you.
- Following the phone call, you should receive a letter from the insurance company stating that it has denied your disability claim or discontinued your disability benefit payments. According to most state and federal law, the letter should have a detailed explanation of the evidence the company reviewed and why the insurer thinks that evidence shows you aren’t entitled to disability benefits. When you receive the letter, read through it carefully. Make notes on a separate document about any inaccuracies you identify.
- Make sure you keep a copy of the denial or termination letter as well as the envelope it came in. You should also make a note of the date on which you received the letter. The date the letter was actually mailed and received could be important to your legal rights in the future. Then, the best thing to do is to scan the documents electronically or make a photocopy for your file, just in case the original denial letter gets lost or damaged.
- Once you find out that your disability claim has been denied or terminated, you should contact a disability insurance attorney. Some doctors and dentists attempt to handle an appeal of their claim on their own, but we strongly suggest at least consulting with a law firm. Every insurance company has its own team of highly-trained claims analysts, in-house doctors, and specialized insurance lawyers to help it support the denial of your claim. Having your own counsel can level the playing field by making sure you know your rights under your policy and what leverage the applicable law provides you, and help you avoid the common traps that insurance companies lay for claimants on appeal.
- The lawyer you consult can be in your area, or it can be a firm with a national practice that’s physically located in another state. You may want to review these questions to ask potential attorneys before you decide who you would like to represent you.
- Whatever attorney you choose to contact, make sure you do so as soon as possible. In many circumstances, you will only have a limited amount of time to appeal the insurance company’s decision. Particularly in claims governed by the federal law ERISA, the clock starts ticking as soon as you find out your disability claim has been denied or terminated.
- It’s usually best to contact a disability insurance attorney before you respond to the denial letter, to avoid saying anything that could prejudice your appeal. For instance, if you have a disability insurance policy that is governed by ERISA, and you submit some additional information, the insurance company may not allow you to submit any additional information after your initial response.
- Before you meet with potential disability insurance lawyers, gather whatever documents you can to help them evaluate what’s going on with your claim. Our firm will always want to review the insurance policy or policies. (Here’s information on how to get a copy of your policy). We typically also like to see your relevant medical records and any correspondence between you and your insurance company. If you aren’t able to locate this information, it could cause delays in starting the appeal process.
- If you are a physician or dentist that is totally disabled, you should not try to go back to work just because your insurance company thinks you don’t qualify for disability benefits. Trying to practice when you aren’t in a physical or mental condition to do so could cause you to re-injure yourself or accidentally harm your patients. Of course, trying to work on patients after you’ve claimed that you are totally disabled can expose you to professional liability as well. Further, trying to return to work could impair your ability to collect your disability benefits upon appeal.
Field Interviews: What to Expect After the Interview Ends
We’ve discussed why a disability insurer might want to schedule a field interview and what to expect before and during the interview itself. Now we review what claimants can expect can expect after the interview ends. Again, the process is usually different depending on whether not a disability insurance attorney is involved.
After the Field Interview
After your interview ends, the field representative will leave to do some additional reconnaissance. Without telling you, the representative may drive to your office to talk to people on your staff. He or she will see what the office looks like, if it’s busy, and whether your name is still listed on the door. If you have a disability insurance attorney, the attorney will have discussed this with you ahead of time, and together you will have taken steps to make sure the representative doesn’t bother your staff or catch them off guard.
Some days after the field interview, the representative will send you a copy of his or her report, which purports to summarize your conversation. The report will ordinarily be 8 to 10 pages or more. He or she will ask you to review the report, make any changes you see fit, and return it. The representative will advise that if you don’t make any changes by a certain date, he or she will assume that everything in the report is accurate.
For claimants with legal representation, the report will be sent to your attorney’s office. Your attorney will review the report to make sure that it accurately reflects the facts of your disability claim. He or she should be able to correct any seemingly harmless statements that a claims adjuster may take out of context to support denying or terminating your disability claim. If any important information is missing, your attorney will make sure to include it along with the report.
Meanwhile, the field representative will usually send a separate report to the insurance company. This second report will have the representative’s personal observations about you, their conversations with your staff, and any other information he or she was able to gather about your outside of the interview. You will not be provided with a copy of this report unless you’re able to obtain the claim file after your disability claim has been terminated or denied. If you have an attorney, this second report will be much more limited, as the representative will not have had the opportunity to visit your home or to pry into irrelevant or confidential information. If your disability claim is denied or terminated, your attorney will obtain and review this report for any inaccuracies or misstatements.
A field interview can be intimidating, but knowing why the interview is being conducted and what to expect during the process can make you better prepared to handle it in a way that doesn’t prejudice your claim. If you have questions or concerns about a field visit, contact a disability insurance lawyer right away.
Field Interviews:
What to Expect Before and During the Interview
Our last post discussed why an insurance company might want to conduct a field visit or field interview. Now that you know what the insurer is trying to accomplish, we’ll discuss what exactly to expect before the interview, during the interview, and afterwards. As with many aspects of the disability claims process, the field interview will be different depending on whether or not you have a disability insurance attorney involved. First, what to expect before and during the interview:
Setting Up the Field Interview
Initially, the field representative will call or e-mail you personally to set up a time to meet. He or she will ask to come to your home, or sometimes your office (particularly if you have been practicing as a dentist or physician), and talk one-on-one. If you’re being represented by a disability insurance lawyer, the field representative will call or write a letter to the lawyer’s office to request a field interview. Your attorney will evaluate whether the in-person interview is necessary and appropriate under the terms of your policy and your particular claim situation. If so, your attorney will likely ask the field interviewer to meet at the attorney’s office, rather than in your home or office. Your attorney, and sometimes an assistant as well, will attend the interview. The attorney and/or his or her assistant will take careful notes of the entire conversation.
During the Field Interview
When the representative arrives, he or she may ask to take your photograph. The representative may also ask to audio-record your conversation. If an attorney is present, the representative will usually refrain from asking to take a photograph or audio-record the conversation, knowing that your legal counsel will likely determine it unnecessary and/or inappropriate.
The field representative will sit down and talk with you for an hour or more. He or she will have an extensive list of questions to ask you, most of which your claims analyst will have specifically requested the representative address. For those with legal representation, your attorney will have prepared you for each of the questions the representative will ask, so you’ll be ready to give accurate and well-considered answers.
During your conversation, the representative will be very warm and friendly. The representative will normally try to establish a rapport so that you’ll relax and talk openly. He or she will try to get you to talk without thinking, encourage you to go into unnecessary detail, and may ask personal questions that a claims adjuster would normally avoid.
The representative often acts somewhat more reserved when a disability insurance attorney is present. Field representatives know that if they ask any questions that are irrelevant, seek confidential information, or are otherwise inappropriate, your attorney will intervene and let you and the representative know that you don’t need to answer the question.
While you’re talking, the field interviewer will take copious notes. These notes will include the interviewer’s own observations about your appearance, how well you move, how long you were able to sit or stand, what your house looks like (if in your home), and whether you seem nervous or not. If your attorney attends, the representative will know that his or her notes will be compared against the attorney’s, so he or she will be especially careful to document the circumstances accurately.
In our next post, we’ll talk about what happens after the field interview ends.
