The 10 Biggest Legal Mistakes Physicians Make When Filing a Disability Claim (Mistake #6)
If you are a physician, dentist, or other professional facing a disabling condition, you may be wondering when to tell your doctor that you’re thinking you may need to file a disability claim, and how to communicate it best. How and when you approach your doctor can have a significant impact on your claim, particularly if you have a slowly progressive condition, like an essential tremor or degenerative disc disease.
Ed Comitz’s article “The 10 Biggest Legal Mistakes Physicians Make When Filing a Claim for Disability,” published by SEAK, Inc. (2005), details ten of the most significant mistakes to avoid. The excerpt below discusses some important considerations to keep in mind when interacting with your doctors:
MISTAKE NO. 6: Engaging in Inadequate Communication with Treating Physician
Physicians should not discuss their claim or that they are considering filing for disability insurance benefit with their treatment provider until after they have had several visits. Physicians are often reluctant to support claims for benefits if they question the motivations behind the claims. A physician who has treated, without success, the physician making the claim will likely be more willing to cooperate. It is also important that the physician making the claim communicate his or her symptoms and limitations to the treating physician in an organized and detailed manner so that all relevant information is recorded in the medical records, which the insurer will ultimately request. When finally speaking to the treating physician about the claim, the physician 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 physicians making the claim to work.
Action Step: Physicians should fully discuss their condition with their treating physician to ensure supportive medical records and, after several appointments, work with him or her on submitting the claim for “disability” as defined in the policy.
Your doctor plays significant role in documenting the health information your insurer will eventually obtain and review when investigating your claim. With that in mind, it is important to understand the relevant definitions in your disability policy, consider the nature of your symptoms and limitations, and carefully consider when to approach your treating physicians about your disability claim.
To learn more about the tactics insurers use to deny claims and other mistakes to avoid, click here.
The 10 Biggest Legal Mistakes Physicians Make When Filing a Disability Claim (Mistake #7)
If you have never filed a long-term disability claim, you may not have given much thought to how to quantify job duties, but if you end up needing to file a claim, this is one of the first questions you’ll be asked on the disability claim forms. It is very important to be careful when filling out these portions of the claim forms, to prevent your insurer from taking advantage of imprecise responses and/or taking your responses out of context in order to deny or narrow the scope of your benefits.
Ed Comitz’s article “The 10 Biggest Legal Mistakes Physicians Make When Filing a Claim for Disability,” published by SEAK, Inc. (2005), details ten of the most significant mistakes to avoid. The excerpt below discusses some considerations to keep in mind when completing this section of your initial claim form:
MISTAKE NO. 7: Quantifying Time
Physicians should be wary of insurance companies asking them to compartmentalize in percentages what activities they were engaged in pre- and post-disability. To the extent that there is any crossover, companies will often deny benefits or provide benefits for merely a residual disability. It is important that physicians broadly describe their important duties—rather than their incidental duties—so that the insurer has a clear understanding of the thrust of their occupation. For example, in response to a question about principal duties and the percentage of time spent on each duty, an anesthesiologist may be better off stating “100% surgical anesthesia” rather than compartmentalizing each and every incidental task (e.g., patient intake, supervising nurses during surgery, postoperative visits) into discrete percentages. The reason is the insurer may erroneously consider an incidental task a “principal duty,” and therefore downgrade the amount of benefits. For example, where a physician has duties as a businessman (e.g., supervising staff, overseeing payroll), the insurer may argue that the disabled physician can still manage his or her practice and is therefore only partially disabled.
Action Step: Physicians should not quantify their time until after they fully understand the definitions of “principal duties,” “disability,” and “occupation” under their policy.
To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.
The 10 Biggest Legal Mistakes Physicians Make When Filing a Disability Claim (Mistake #8)
After submitting a claim for long-term disability benefits, it is important to keep in mind that your insurer will almost certainly conduct surveillance at some point (and many insurers use surveillance throughout the entire claim). Traditionally, insurers used private investigators and interviewers to conduct surveillance, but ever-advancing technology is providing insurers with even more tools to conduct surveillance, such as social media, online public record searches, and potentially GPS tracking, drones, stingrays, and other electronic methods of tracing your activities more closely and accurately than ever before (depending on whether lawmakers act to curb abuse of these new, emerging technologies).
Ed Comitz’s article “The 10 Biggest Legal Mistakes Physicians Make When Filing a Claim for Disability,” published by SEAK, Inc. (2005), details ten of the most significant mistakes to avoid. The excerpt below explains why you should be aware of the potential for surveillance:
MISTAKE NO. 8: Ignoring the Possibility of Surveillance
Insurers are likely to videotape or photograph physicians who have filed for disability insurance benefits. Physicians who engage in any activities that they claimed they could not perform and are caught on tape are likely to have their benefits denied and the contract could be terminated.
Action Step: Physicians should not compromise their policy benefits by submitting a fictitious claim.
If you are considering submitting a long-term disability claim, remember that modern technology enables insurers to harvest information about you from the internet, and remain wary of suspicious situations that may be the insurance company’s investigators using pretexting to obtain information about you (for example, “friend” requests from individuals that you do not personally know may be efforts to gain access to your social media accounts).
Excessive, unnecessary surveillance can rise to the level of bad faith, and too often these types of methods are misused to manufacture “evidence” that insurers take out of context to terminate (and/or delay) benefit payments. If you think your insurer may be misusing surveillance in your claim, you should talk to an experienced disability insurance attorney and he or she can evaluate whether or not the scope of the insurer’s investigation is appropriate.
To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.
The 10 Biggest Legal Mistakes Physicians Make When Filing a Disability Claim (Mistake #9)
Many insurance companies tell physicians, dentist and other professionals who have filed a long-term disability claim that their claims will not be approved unless they can produce objective evidence of their disabling condition. While some policies do contain express provisions limiting coverage for subjectively diagnosed conditions, many policies do not. In fact, your policy may be less exacting and require only verifiable evidence of disability. Under such a policy, you may still be able to collect if you can show that the cumulative effect of your symptoms and limitations are disabling.
Ed Comitz’s article “The 10 Biggest Legal Mistakes Physicians Make When Filing a Claim for Disability,” published by SEAK, Inc. (2005), details ten of the most significant mistakes to avoid. The excerpt below explains why verifiable evidence of disability is important, even for subjective conditions:
MISTAKE NO. 9: Blindly Accepting that Subjectively Diagnosed Conditions Are Not Covered
Disability insurers often deny benefits by insisting that the insured’s subjective symptoms do not provide objective, verifiable evidence of disability. In many cases, there is no provision or contractual requirement mandating that the insured submit objective evidence of disability. Therefore, from the insured’s perspective, these insurance companies are merely trying to save money by generously interpreting policy language in favor of a claim termination. Notwithstanding the subjective nature of a particular condition, the insured may be able to secure benefits with ample evidence bearing on the extent and severity of his or her limitations, which is far more important than providing a definitive diagnosis.
Action Step: The severity and extent of the limitations are more important than an objectively verifiable diagnosis and must be fully communicated to a physician’s insurer.
If you are a physician or dentist suffering from a subjectively diagnosed condition, it is important to present your conditions and limitations in a precise and detailed fashion from the outset of your claim. At a minimum, this requires a supportive treating doctor who is willing to take the time to thoroughly document the extent and severity of your symptoms in your medical records.
To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.
The 10 Biggest Legal Mistakes Physicians Make When Filing a Disability Claim (Mistake #10)
Many physicians, dentists and other professionals who purchase disability insurance do not pay much attention to the policy and related documents once their application has been submitted and approved. Because of this, many of the professionals we consult with cannot find their policies when it comes time to file a claim, and many professionals are surprised to learn what their policies say, because they didn’t read them carefully when they first received them.
Ed Comitz’s article “The 10 Biggest Legal Mistakes Physicians Make When Filing a Claim for Disability,” published by SEAK, Inc. (2005), details ten of the most significant mistakes to avoid. The excerpt below explains why you should keep copies of all of your insurance documents:
MISTAKE NO. 10: Tossing Out Application, Policy, and Claims Documents
From the time of application forward, physicians should keep copies of everything (including notes from meeting with the insurer’s sale representative or agent, the policy application, and the policy itself). If the sales representative provided a letter or verbal representation that the physician jotted down, those notes can go a long way if the insurer says that the policy says something different. Similarly, information that the physician provided on the application may have a bearing on his or her reasonable expectations at the time of purchase.
Action Step: Physicians should keep all of the disability insurance papers and notes in an organized file.
If you end up losing your policy, you do have a right to request a duplicate copy from your insurer. However, it can take several weeks for insurers to process these requests, and your insurer may also use the request as an opportunity to interview you before you know what your policy says, and before you have a chance to speak with a disability insurance attorney about your claim.
Depending on your condition and the progression of your symptoms, if you don’t keep a copy of your policy, you may also be forced to decide whether you are going to file a claim without a complete understanding of what your policy says. This is not a position you want to be in, and it is therefore best to keep all of your policy documents so that you have them on hand if you need them.
To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.
