Disability Insurance Claim Advice
What to Expect ifYou File a Disability Claim
Chiropractic Economics, April 29, 2005
By Art Fries
Disability claims for chiropractors are different from those of most of your patients. Many individuals may be able to function with cervical, thoracic or lumbar problems, or at least work in a reduced capacity.
However, a chiropractor can be physically and financially debilitated if these symptoms become chronic and affect performance.
Repetitive movements put strain on your body. Carpal tunnel syndrome and other hand and arm problems are occupational hazards for chiropractors. You may reach a point at which you are not effective in treating patients because of pain. Pushing yourself to do a proper adjustment can put added stress on injured areas and, over time, lead to permanent damage.
Sometimes reducing your hours can help, so that you can continue working on a part-time basis. In many situations, however, it is necessary to cease performing manipulations.
Many individual disability policies available to chiropractors provide partial or total disability benefits, often to age 65 and sometimes for life. The working is often occupation-specific, meaning that if you cannot perform the substantial and material duties of a chiropractor, the insurance company will pay you the full amount of the benefit.
Although an insurance company may make certain promises in the way of a disability contract, these broadly worded policies sometimes leave a trail of “red ink” that bring about claim management practices chiropractors never envisioned at the time of policy purchase.
To control claims, many insurance companies use defensive measures that make the claim process difficult. These measures include field investigations (a personal visit with you), independent medical evaluations (IMEs), functional capacity evaluations (FCEs), video surveillance, forensic audits and a host of others:
Field Investigation. A field investigation can be done by appointment or may be unannounced. You may be asked to read and sign a statement prepared by the investigator. Read it carefully at another time and return it to the investigator with appropriate corrections.
IMEs and FCEs. IMEs are performed with most claims even when the claimant’s symptoms can be verified by the attending physician. Insurers now use FCEs more frequently, with claims related to musculoskeletal and hand and arm problems.
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 a claim and can do so repeatedly until the claim is settled.
CPAs. Insurers frequently use forensic CPAs (accountants) on partial disability claims to dispute the pre- and post-disability earnings figures provided by the claimant. A compromise may be necessary to arrive at a figure acceptable to both parties.
Note: Do not discuss over the telephone any calculations related to financials. Instead, ask the insurance company to send you a written list of questions, which your accountant can review. The CPAs for both sides can then discuss the issues.
How you submit a disability claim on paper and how you behave in your personal life can determine whether your receive a settlement. Most physicians do not know the difference between a workers’ compensations claim, a Social Security disability claim and your personal or overhead disability policy(s).
Your attending physician my need help with the policy language and the meaning of some questions on the attending physician statement. Although scarce, disability claim consultants can provide help in the various aspects of your disability claim so that you and your treating physicians do not make any mistakes.