Disability Insurance is like the ejection seat on a fighter plane, it had better work or you are toast. Disability Insurance is one of the most important investments you will ever make as a dentist. Although the need is not immediately realized, the security and peace of mind that it brings is invaluable. Hopefully you have already purchased a good policy.
You are now faced with a disabling illness or accident with the prospect of not being able to work and receive an income to support your family. OF COURSE, this is why you purchased your policy to begin with. You never thought it would be needed, but now you need it more than ever. Don’t worry, everything will work out fine; but you need to proceed in a firm and confident manner. Knowledge is power in this case, and following our recommendations is advisable.
Dentists who are considering filing a claim for disability insurance benefits can rest assured that the Disability Company that they have a contract with will follow that contract to the letter of the law. They will not go beyond that. Disability Insurance Companies are not your friend, they are a for profit company with a bottom-line to deal with. Your policy with have specific conditions and clauses in it to protect both you and the insurance company. You may want to consider meeting with an attorney experienced in the area before submitting a claim , IF YOU HAVE A CONDITION THAT HAS THE POTENTIAL TO BE CHALLENGED. Claims for severely disabling illnesses/accidents although they cannot be considered routine; they can successfully be submitted by the dentist directly. Examples of potentially challenging claims include psychiatric and orthopedic (back and neck) claims.
Dentists should not discuss their claim or that they are considering filing for disability insurance benefits with their current treatment provider until after they are considered an established patient of record by faithfully keeping multiple appointments/visits with their physician(s). Physicians may be reluctant to support claims if there is any question in the motivation behind the claim. Remember you most likely have a 90 day waiting period before you are eligible for claim payments and this gives you time to work with. Dentists should fully discuss their condition with their treating physician to ensure supportive medical records. Involving a rehabilitation physician (doctors who specialize in disabled patients) is an option as they deal with insurance disability claims frequently. Make sure you communicate your symptoms and limitations in an organized and detailed manner. Your insurer will request all your medical records from all your treating physicians. The severity and extent of your limitations are more important than an objectively verifiable diagnosis and must be full communicated your physician and your disability insurance company.
Call your disability insurance company(s) and inform them that you have encountered an illness/accident that prevents you from working. Remember, everything you say will be recorded. Be honest and informative of the events surrounding your event. You do not need to elaborate, these companies deal with the process every day. This is your first time. JUST THE FACTS are what is relevant to them, no need to provide them with any ammunition to use against you later. When you are emotional and ill it will be easy to say something that could be misinterpreted later on. Take notes to assist you in remembering what is said by all parties. Note the time and date and identify the person to whom you are speaking. Your carrier will follow up with a letter confirming your claim with a set of instructions to follow. Remember if you are ever asked what your job description is, the answer that is open to the least misinterpretation is 100% clinical dentistry. Avoid quantifying your time if possible.
Your disability company will follow your initial contact with them with detailed requests for information. Don’t worry, this is standard and is done to protect the insurance company from fraud. It also will allow your claim to be considered in a timely manner, if you respond appropriately with the requested information. It will ultimately make your claim stronger. You will be required to submit your recent income tax returns, your recent work schedule to include what procedures you have done , and a detailed list of all physicians and hospitals that have been treating you. This may sound like a lot, but lets the insurance company know at what capacity you were working before your accident/illness. Depending on your policy provisions this will allow them to evaluate your eligibility for benefits.
You will have previously selected an elimination period when purchasing your policy, this could be 30-180 days but will most likely be 90 days. Do not delay too long in starting the claims process. Our recommendation is to contact them within 60 days. This allows you some time to determine if that cough you have is just a cold or lung cancer for example. Once you start the process, your insurance company will periodically contact you asking if you want to close your claim. That would make them happy, but they aren’t you and have no idea if you magically got better. THEY DON’T CARE. They are strictly following the law. The law is on your side and by being completely honest and prompt with your communication with them helps everyone involved. Be aware there are deadlines in this process and are spelled out in meticulous detail in your policy, don’t miss any and you will be fine.
Once your carrier has all the requested information and the elimination period is reached, they will contact you with a letter /phone call indicating a denial or approval of benefits. Be aware, just because they approve your claim , they have the option of withdrawal of benefits at anytime within the legal definitions of your policy. You must continue to see a physician for care on an annual basis, and submit relevant documentation to your carrier on periodic basis. If you are only partially disabled, you may be eligible for partial claim payments based on the provisions of your particular policy. Keep a organized file of all correspondence along with copies of you policy and notes taken during the entire process to include what was said when you initially purchased the policy . Make sure this data is kept in a safe place.
If your claim is denied, realize that there is an appeals process that is outlined in detail in your policy. In our opinion, this is the time to immediately seek legal assistance. Demand that all further communication be in writing by certified mail with copies to your attorneys. Insurance denial protocols are well documented, and your strong claim is the best assurance that the appeal process will be short and in your favor. The tactics used in the 90’s are well known, and insurance companies know the cost of a BAD FAITH lawsuit. Get not only the best legal representation, but attorneys with experience in private disability claim denials. There is no shortage of specialists in this area, and avoid the social security firms that do not deal frequently with private disability policies. Understand that there is no such thing as a “standard” disability insurance policy. The definitions of total disability can vary significantly. Most dentists purchase “own-occupation” policies which provide compensation following a disability that prevents the insured from performing the particular duties of his or her occupation. Thus, the insured may be entitled to benefits even if they could in fact perform work of a different nature. Fully understand your policy and terms before filing a claim. The legal language is very confusing at times, but ultimately will help you prevail. Your attorney will be the driver at this point.
Congratulations to you, if you have survived the process of filing a claim and having it approved. Understand that to save money, your disability company may attempt to “buy you out” at some point following your approval of benefits with a lump sum payment. This payment will be in place of all further payments and may terminate your relationship with the insurance company. It may be a significant sum (one million) or just pennies on the dollar. It is a very personal decision to accept such an offer, and you should involve all interested parties along with your attorney/spouse. Look honestly at your medical condition, prognosis, physical capabilities, and value of your current policy if paid in full. If you are eligible for benefits for 20 more years compared to someone with only 7 years of benefit eligibility this will strongly influence your decision.
Understand that your benefits will most likely be paid monthly, and under no requirement to have taxes paid on them if you previously paid your premiums with post-tax dollars. Stop now and immediately prepare a budget based on your benefit amount. Be flexible and continue to understand that your benefits will always be at risk for termination, and have an emergency fund/plan in pace in case you have to go to war with your carrier.
Once you start receiving disability payments, you still have the option to return to work at some point. This may involve returning to your old practice, starting a new practice or transitioning to a completely new career. Your benefits will terminate if you return to work as a dentist at the same rate and capability as before your accident or illness. You will need to start paying your premiums again and make sure to keep your policy active. You may need it again for a completely different accident or illness. In addition, there is no guarantee that your original condition may not recur and prevent you from working. You work hard as a dentist, and you deserve the piece of mind and security that Disability Insurance provides. It is there for a reason, do not be ashamed of using it. Move forward with confidence and renewed strength.