If you thought Halloween was “scary”, then you haven’t been through the claims process with a disability insurance company. The Companies maintain an arsenal of well-paid, well-trained professionals and claims staff who sometimes seem like they are masquerading at a holiday costume ball. The reality is that the claims process may very well become the consummate “trick or treat” experience. Your goal in filing your claim is to obtain your disability insurance benefits, and as quickly as possible, during a period in your life when you are disabled, most vulnerable, and in financial need. Although this process will never be […]

Spring approaches, one thing that is as certain as “April showers bring May flowers” and kids playing in the park, for you, the disabled physician, claiming benefits under your group long term disability policy is the same as “hope springs eternal”. Almost every disabled physician looking to his or her group policy as part of a financial safety net to maintain your hard-earned quality of life will unfortunately be in for a rude awakening trying to maintain their claim, or even get paid in the first place. Instead, often-times the reality of successfully bringing a claim under your group LTD […]

Do you know your “own occupation”? Chances are you don’t! Sounds like a rather simple and straight forward question. But, when you bring a claim for benefits under your disability insurance policies, your company will redefine the “kiss” rule to be the “kicc” rule: keep it complicated and confusing. “Own Occupation” policies were, and still are, the “Cadillac” policies (or “Mercedes” depending of your auto preference). They are the “creme de la creme”; and when it comes to individual disability income policies, they are the policies held by most physicians. The term is so basic to these policies that the […]

Louis E. Baxter, Sr., M.D, F.A.S.A.M. Mark F. Seltzer, J.D. The impaired health care professional has become the focal point of many recent legal proceedings. The problem of practitioner impairment was resurrected in 1999 when the National Institute of Medicine published a report entitled Medical Errors. The report stated that each year nearly 100,000 patient deaths were a result of mistakes made by medical personnel. The question of health care professional impairment was raised. Accordingly, it is important that these health care providers are identified and whenever possible treated. With the advent of the Joint Commission on Accreditation of Health […]

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 […]