Disability Insurance Claim Advice
Discrimination Against Chiropractors Related to Disability Claims
The Chiropractic Journal, February 2010
By Arthur L. Fries, RHU
Are chiropractors being treated fairly on disability claims? The answer appears to be NO based upon current claim management practices of disability insurance companies.
WHAT ARE SOME OF THE REASONS FOR THIS ATTITUDE:
- A changing work ethic. In prior years most professionals (physicians, dentists, chiropractors) worked until “they dropped.” Managed care (HMO’s, PPO’s, etc.) started telling professionals “how to do it” and “how they would get paid” certainly contributed to the economic aspects of a chiropractor’s earnings. That alone is not a basis for submitting a disability claim. Example: You WERE earning $300,000 per year after overheard expenses and currently are earning $150,000 per year and not working any less hours. You purchased disability policies 10 or 15 years ago based on adjusted gross earnings (fees less overhead) of $300,000 per year. This entitled you to purchase $10,000 monthly benefit payable to age 65 (and possibly for life). If premiums were paid on a personal basis (and not deducted by a corporation) that’s $10,000 a month TAX FREE, which might be close to what you are currently earning working full time AFTER TAXES. Some typical chiropractor claims involve hand, cervical and low back problems. You may also have a thoracic problem and every time you do a “side posture” on your patient it feels like someone has inserted a steel stake through your upper back. Any one or combination of these symptoms could be the basis for a total or partial disability claim. At $300,000 per year earnings you might have “toughed it out.” At $150,000 per year you’re ready to “throw in the towel” and be “normal” like others who put in disability claims. Understand that you MUST HAVE MEDICAL SYMPTOMS and those symptoms are a danger to yourself as well as your patients if you continue to work performing chiropractic manipulations. “Holding back” on an adjustment is not going to instill confidence in your patient who is seeing you for low back pain or cervical pain. And continuing to “hold back” will cause your patient base to erode as they seek help elsewhere.
- Individual disability policies written in the ‘80s and up to the mid ‘90s had very broad wording. In retrospect, these policies were priced too low. Many insurance companies tripped over themselves for market share expanding benefits and being more “hang loose” relative to prudent underwriting standards. Insurance companies earning high rates of interest (remember 16% and 17%) also contributed to this atmosphere and did not consider the long-term implications of their unfortunate decisions. The “red ink” started to flow in the mid ‘90s in terms of profitability, and senior claim management personnel looked for ways to stem the tide of money leaving “their bank,” creating a whole new scenario related to claims handling. Claim forms were created with “trick questions”…ambiguous at best…for both the claimant and the attending physician to complete. More vigilant use of video surveillance, field investigations, I.M.E.’s (Independent Medical Evaluations), F.C.E.’s (Functional Capacity Evaluations), and layers of inside and outsourced medical and financial consultants to review claim files were additional weapons used to provide further opinion as a basis for denying or terminating disability claims.
- In spite of the more recent years providing horrendous claim experience for physicians and dentists, chiropractors seem to lead the pack, as one’s hands are an integral part of treatment modalities. As one who has used chiropractors for some 25 years, I’m well versed in the type of treatment offered and how a chiropractor not feeling 100% healthy can have an impact of their ability to render a proper manual adjustment.
- By providing a chiropractor a “Your Occupation” definition for total disability, incentives were created for one to work at another job (not in conflict with medical symptoms) but no longer as a chiropractor. In turn, product availability and contractual wording, in more recent years has become very restrictive and many insurance companies are looking for a “way out” not to honor a legitimate disability claim.
In spite of the comments made, there are disability claims that should not be paid based on fraudulent statements made when coverage was applied for. Most insurance companies have protected themselves with fraud clauses in their contracts and are protected even after the 2-year incontestability period goes into effect. Those insurance companies that were ‘dumb enough’ not to include a fraud clause (approx. 15% by my estimate) are “stuck” with the claim if the claim occurs after the policy has been in force for 2 years.
In order to prevent money being paid to claimants because of the insurance company’s “mistake,” claim management methods not previously used have now surfaced which are as disturbing to me (who has previously sold product) as it is to chiropractor claimants who are going on or are now on a disability claim. How much TIME you spend and amount of money doing manual adjustments, management duties, setting up additional offices, selling vitamin supplements and other uses of business time can all have an effect on the definition of total disability. Or, if you or your attending physician do not understand the significance of even one question on a claimant’s statement/attending physician statement, and do not answer correctly, that can be the basis for denial or claim termination.
Taking RX’s for a herniated disc may lessen or temporarily eliminate the pain, but it will only “mask it,” with symptoms often worsening or have side affects (bleeding ulcers, lack of focus, etc.). A chiropractor taking medication would certainly open themselves to liability if they were to “hurt” a patient while medicated.
Knowing the proper course to take as it relates to a disability claim is the job of a disability claim consultant. Just as I don’t want a plumber adjusting my back, you shouldn’t have the equivalent of a plumber giving you advice on a disability claim. A legitimate disability claim should be paid as it relates to policy language and not on the economic incentives “wished for” by claim departments of insurance companies.