Disability Insurance Claim Advice
Disability For Dentists
Dental CE Digest (Volume 3, No. 1), Januray, 2006
By Art Fries
The dental professional faces a wide array of occupational hazards in the workplace. Many may be able to function fully or partially with musculoskeletal, hand, or arm problems, such as Carpal Tunnel Syndrome, but if these symptoms become pronounced enough to affect performance, the consequences can be physically (and financially) devastating.
If your pain is so great it interfaces with your ability to treat patients, something must be done. In some instances, all it takes is cutting back on those office hours and working part-time, but in others, walking away from the profession is necessary to avoid causing permanent damage. In either case, a disability claim is likely in your future.
Many individual disability policies available to dentists provide partial or total disability benefits, usually to age 65 and sometimes for life. Their working is often occupation-specific, meaning that the insurance company will pay you the full benefit amount if you cannot perform the substantial and material duties of your occupation.
Despite the promises your insurance company may have made in your disability contract, it’s almost guaranteed that you’ll need to wade through a sea of red tape and fine print before you receive any benefits.
Many insurance companies use defensive measures to control and substantiate claims. Unfortunately, these also make the process more difficult and time consuming. Here’s a brief rundown on what your claim might entail.
FIELD INVESTIGATION. A field investigation is a visit from a representative of your insurance company. This is generally by appointment, although it could be unannounced, and you may be asked to sign a statement prepared by the investigator. Read it carefully and make any necessary corrections before returning on another day. Take as much time with the statement as you need to insure its accuracy.
IMES. Independent medical examinations, or IMEs, are preformed with most claims even when the claimant’s symptoms can be verified by the attending physician.
FCES. Functional capacity evaluations, or FCEs, are used frequently with the claims a dental professional is most likely to file, such as those involving back or hand pain.
SURVEILLANCE. Video surveillance is used to determine whether your medical symptoms are in conflict with your lifestyle. Insurers closely monitor athletic and social activities early in the life of your claim and may continue to do so on a long-term basis.
FINANCIAL INVESTIGATION. Insurers frequently use forensic accountants on partial disability claims to dispute the pre- and post-disability earnings figures provided by the claimant.
Generally speaking, it’s inadvisable to discuss financial calculations with your insurer. Instead, ask them to send a written statement for your accountant to review and, if necessary, discuss with your insurer’s accountants.
Your attending physician may need help with the policy language and documentation. In fact, most attending physicians, don’t know the difference between a Workers’ Compensation claim, a Social Security disability claim, and your personal disability policy. A disability claim consultant can help clarify all aspects of your claim for you and your physician.