Editors Note: This is Part II in a two-part series. Read Disability Insurance Claims: Protecting Your Asset (Part I) Welcome back from, what was hopefully, a nice summer vacation and a long intermission from Part I of my Article published in the July/August edition of FYI by the Pennsylvania Chiropractic Association. Let’s get back to reality. . . Now that you understand some of the history and background that preceded your current need for your disability insurance benefits, and the fact that these policies are unique contracts that must be satisfied every month, while you are on claim, in order […]

Editors Note: This is Part I in a two-part series. As a chiropractor, engaged in the active practice of chiropractic, you are customarily used to routinely dealing with insurance carriers considering payment of your bills for professional services rendered. However, what you probably haven’t been exposed to is trying to get paid by your disability insurance company. The latter, is not only a totally different situation, but it comes at a time when you are most vulnerable and most in need of these insurance proceeds. While your years of training and developing your expertise in chiropractic have taught you how […]

The word “Faith” is ingrained in American society and the American way of life. It is the bastion of religious belief as well as the trust that allows us to achieve a comfort level to deal with others in our every day lives. So too is this “faith” ingrained in the very fiber of a contractual relationship between parties. The Restatement of Contracts 2nd speaks of the basic premise upon which all contracts are based as the concept of “Good Faith and Fair Dealing” which is assumed in the performance of contractual obligations and provisions. It is then no surprise […]

What you never learned in dental school was what to do if disability struck and you could no longer perform clinical dentistry. When you purchased disability insurance for this purpose, no one could foresee the future of the disability insurance industry. By the 1980s, healthcare professionals were the favorite target market of insurance companies writing disability insurance policies. The competition was extreme between various insurance companies vying for increased market share. As a result, contract benefits were expanded, language was liberalized, and underwriting standards were often relaxed. However, by the 1990s, the disability insurance climate began to change dramatically. As […]

Do you know if you can bring a Bad Faith claim against an insurer with an ERISA governed disability insurance policy? As of September 2004, the answer to this question is: No. Chief Judge Anthony Scirica, writing for the United States Court of Appeals for the Third Circuit last fall, in Barber v. UNUM, ended years of judicial debate about whether ERISA preempted Pennsylvania’s Bad Faith Statute under it’s broadly interpreted preemption clause. The Court held that Bad Faith is preempted under ERISA, under both the doctrine of conflict preemption and under express preemption. This decision effectively put to rest […]

The fact is that disability insurance companies are becoming more aggressive in attempting to find ways to deny claims. All provisions of your disability insurance contract must be satisfied in order to make the company obligated to pay you benefits. The definition of either total or residual disability typically contains a second condition, which not only has to be met in order for you to receive your disability income, but which is fast becoming a weapon in the company’s arsenal of ways to attack claims. I am referring to the physician’s care provision, or the issue of “appropriate care.” You must […]

Do you have group long-term disability coverage that pays you if you become disabled? If you get sick or hurt, are you relying on that group LTD policy to pay you benefits? If so, don’t count on it. There are three primary reasons for this: (1) inferior contract language, (2) ERISA, and (3) relevant court decisions. If you become disabled, you may be in for the fight of your life. Unfortunately, when you are disabled and at your most vulnerable is the worst time to mount a fight against a big insurance company. As you read this article, think how […]

Since my last article appeared in this publication in March 2001, there has been even more press, in this publication and others, about difficulties related to payment of disability benefits. This is just not anecdotal; more physicians call me now, and call earlier in the claims process, for assistance with their disability insurance claims. Although many claims are paid, the insurance industry has become more restrictive in its acceptance of liability of a claim. For instance, several disability carriers have required that the insured provide objective evidence of disability, notwithstanding the fact that such a provision or requirement does not […]

As an attorney representing physicians and health care professionals with disability insurance claims, I often find what appears to be a trend: many disability insurance companies are taking a more “hard line” approach when it comes to paying out benefits on their disability insurance policies. This position applies to the full gamut of claims that I see in the course of my practice, including claims for drug and alcohol dependency, psychological and psychiatric conditions, cardiac conditions, orthopedic claims as well as other mental/nervous and physiologic conditions. Back in the 1980’s physicians were the favorite “target market” of the numerous insurance […]