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THE PHYSICIAN DISABILITY INSURANCE LEGAL BLOG

This blog is designed as a resource for physicians whose insurance carriers have wrongfully denied their disability insurance claims or attempted to stop paying benefits.

It is part of our firm's commitment to service to keep medical professionals (and others) apprised of industry, regulatory and legislative changes. If you would like more information about our firm or the timeliness/impact of disability insurance denials on doctors in particular, please feel free to visit our disability insurance attorney website at http://www.disabilitycounsel.net/.


Physician’s Guide to Choosing a Disability Insurance Policy

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For doctors, disability insurance can be an essential step for protecting income in case they no longer practice. However, the insurance industry has made policies so confusing that it can be difficult to choose the right disability policy with the best chance of obtaining benefits. To that end, disability insurance attorney Ed Comitz offers these tips on choosing the best policy:

1. Purchase a policy right after medical school. If you buy the policy when you are just starting out, you are likely to get a more competitive rate.

2. Make sure to get “own-occupation” rather than “any occupation” coverage. To understand the differences, see our explanation of policy types. If you have a specialty, it is also a good idea to get an occupational specialty rider, which will clearly define your “own occupation” as that of a specialist in your field instead of a general physician.

3. Get the highest benefit amount you can afford. If you are unable to practice, the monthly disability insurance payments you receive might be your only source of financial support.

4. Double check the policy for exclusions. These indicate that the policy won’t cover certain types of disabilities, such as mental health or subjectively reported illnesses. The best policies will not have these exclusions.

5. Get a cost-of-living adjustment (COLA) clause or rider. A COLA provision will increase your potential benefits to adjust for inflation as time passes.

6. You may also want a short elimination period. The elimination period outlines the number of days you have to be disabled before you can receive benefits.

Edward O. Comitz, Esq. heads the Health and Disability Insurance Practice Section at Comitz | Beethe, 6720 N. Scottsdale Rd., Suite 150, Scottsdale, Arizona 85253, (480) 998-7800. Mr. Comitz has extensive experience in disability insurance coverage and bad faith litigation, primarily representing medical and dental professionals in reversing denials of their disability claims. For more information about disability insurance issues, please visit our disability insurance attorney website at http://www.disabilitycounsel.net.


When Doctors Become Patients

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A recent New York Times article by Eric D. Manheimer, medical director of Bellevue Hospital Center and author of the memoir “Twelve Patients”, gives a firsthand account of what it’s like for a physician to suddenly become a patient.  This is often foreign territory for disabled physicians, especially those finding themselves having to seek regular treatment for a disability insurance claim.

For my doctors, it was all about the numbers, the staging of my cancer, my loss of weight and strength. For me, too, it was about the numbers: the six feedings I pushed through the syringe into the plastic tube in my stomach every day; the number of steps I could take by myself; how many hours I had to wait before I could grind up the pill that allowed me to slip into unconsciousness.

Being both a doctor and a patient is challenging enough without also trying to be your own lawyer.  An experienced disability insurance lawyer can be invaluable in assisting you with the filing of your claim and helping you navigate any obstacles thrown your way by your disability insurance carrier.

Edward O. Comitz, Esq. heads the Health and Disability Insurance Practice Section at Comitz | Beethe, 6720 N. Scottsdale Rd., Suite 150, Scottsdale, Arizona 85253, (480) 998-7800. Mr. Comitz has extensive experience in disability insurance coverage and bad faith litigation, primarily representing medical and dental professionals in reversing denials of their disability claims. For more information about disability insurance issues, please visit our disability insurance attorney website at http://www.disabilitycounsel.net.


Don’t Toss the Policy: Important Documents for a Disability Insurance Claim

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If you are a physician, dentist, or other professional considering filing a claim on your disability insurance, there are some important documents you should collect and keep organized in order to properly understand and document your claim, including:

  1. Your disability insurance policy
  2. The application for insurance
  3. Notes from meetings with the insurer’s sales agents and letters exchanged with them
  4. Notes of telephone conversations with your staff at your insurance company
  5. Letters exchanged with your insurance company
  6. Emails exchanged with your insurance company
  7. Medical records
  8. Billing records from your medical or dental practice
  9. A daily pain journal, if applicable.

Be sure to keep all of your disability insurance paperwork and notes in an organized file, and if you have to file a claim, consider contacting an experienced attorney who can assist you with interpreting your policy, presenting your claim, and communicating with your insurer.

Edward O. Comitz, Esq. heads the Health and Disability Insurance Practice Section at Comitz | Beethe, 6720 N. Scottsdale Rd., Suite 150, Scottsdale, Arizona 85253, (480) 998-7800. Mr. Comitz has extensive experience in disability insurance coverage and bad faith litigation, primarily representing medical and dental professionals in reversing denials of their disability claims. For more information about disability insurance issues, please visit our disability insurance attorney website at http://www.disabilitycounsel.net.


Once ERISA, Always ERISA: How and why to avoid having your disability insurance policy controlled by The Employee Retirement Income Security Act of 1974

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Disability insurance carriers have increasingly used The Employee Retirement Income Security Act of 1974 (ERISA) to their advantage.  While ERISA was supposed to be for the protection of employees, it is actually being used to protect insurance companies and employers.  ERISA leaves insurance policyholders little leeway, because it preempts more stringent state insurance laws and allows insurance companies to insert language into the policies they issue that makes it easier to deny claims.  Despite these disadvantages, the policyholder is not necessarily doomed to fail provided that he or she takes appropriate measures before filing suit—often, consulting with an attorney before filing a claim can substantially increase the odds of receiving benefits.  It is important to understand your policy now, so as to prevent the double disaster of incurring a disability and not being able to recover the benefits that you deserve.

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Disability Insurance and the Specialized Anesthesiologist: Understanding and Protecting Your Investment

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By Edward O. Comitz, Esq. and Patrick T. Stanley; Published in Anesthesiology News

As the practice of medicine has evolved and become increasingly more complex and specialized, many physicians no longer describe themselves as simply doctors or surgeons, or even by their broader area of practice.  Instead, many physicians, particularly in areas like anesthesiology, are categorized by fellowship training or their sub-specialty.  Anesthesiologists can obtain fellowship training in cardiothoracic, pediatric, neurosurgical and obstetric care, among other things, and can receive certification by the ABMS in the sub-specialties of pain management, emergency room/critical care medicine, and hospice/palliative care.  Although all types of anesthesiology require dedication and training, various focus and sub-specialty areas have markedly different duties and responsibilities, and require unique skills, training and physical abilities, a thorough understanding of which impacts how your own-occupation disability insurance policy should be interpreted.

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Arizona Disability Insurance Bad Faith and Delegation of Administrative Duties

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Under the law in Arizona, the relationship between insurer and insured is a special relationship, giving rise to duties not usually found in other contractual agreements. Rawlings v. Apodaca, 151 Ariz. 149, 163, 726 P.2d 565, 579 (1986); Dodge v. Fidelity & Deposit Co., 161 Ariz. 344, 346-47, 778 P.2d 1240, 1242-43 (1989). Courts in Arizona further recognize that an insurer’s duties to its insured are non-delegable and that an insurer remains liable for actions taken by a delegate:

[A]n insurer who owes the legally imposed duty of good faith to its insureds cannot escape liability for a breach of that duty by delegating it to another, regardless of how the relationship of that third party is characterized. Clearly, an insurer may seek assistance by delegating performance of its duty of good faith to non-servants through whatever organizational arrangement it desires. In doing so, however, the insurer cannot give this delegate authority to deprive its insureds of the benefit of the insured’s bargain. If the insurer were allowed to delegate the duty itself, an injured insured would have no recourse for breach of the duty against either the insurer, from whom the duty is owed, or its delegate, with whom the insured has no contractual relationship. Such a result would render a cause of action for breach of the duty virtually meaningless. Thus, we hold that, although an insurer may delegate the performance of its duty of good faith to a non-servant, it remains liable for the actions taken by this delegate because the duty of good faith itself is non-delegable.

Walter v. Simmons, 169 Ariz. 229, 238, 818 P.2d 214, 223 (Ct. App. 1991) (citations omitted) (emphasis added); see also State Farm Mut. Auto. Ins. Co. v. Mendoza, 2006 WL 44376, at *12 (D. Ariz. Jan. 5, 2006) (“Insurers cannot escape their duty of good faith and fair dealing by delegating tasks to third-parties . . . .”) (citing Walter).

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September is Women in Medicine Month

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In the past thirty years, the number of female physicians in the United States has increased by 430%, with nearly a third of all American physicians and one-half of all American medical students being female. Disability insurance attorneys Comitz | Beethe join the American Medical Association, which has a one-third female Board of Trustees, in supporting the contributions and successes of female physicians by recognizing Women in Medicine Month.

The AMA Women Physicians Congress (“WPC”) serves as a forum for advocacy on women’s health issues and identifies and addresses issues important to female physicians through all phases of their careers.

Although women in medicine have made tremendous strides since Elizabeth Blackwell became the first female medical school graduate in 1849, there is still work to be done to advance the progress of women in the medical profession. At the AMA, the WPC is working to increase the number and influence of women physicians in leadership roles. — AMA President Peter W. Carmel, M.D.

The AMA provides a forum for women in medicine through mentoring and leadership development. By promoting women’s health issues and empowering female physicians, our entire profession benefits. — AMA-WPC Chair Claudia L. Reardon, M.D.

The next caucus of the AMA Women Physicians Congress is scheduled to take place in New Orleans this November.

The disability insurance attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Scottsdale, Tucson, Flagstaff and Yuma. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.

 


DISABILITY INSURANCE AND THE PHYSICIAN: CAN YOU COLLECT ON YOUR POLICY?

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You have worked as a physician for your entire career.  Your spouse and children rely on you, and you have numerous financial obligations both at home and at the office.  The stress and trauma of a disability can cause you significant problems, including, for example, the financial requirement that you contribute toward business overhead even when you are not raising revenue. To protect yourself in case of total or partial disability, you have purchased disability insurance.

Unfortunately, you suffer an injury or become so ill that you cannot continue your career, and you then file a claim with your insurance agent.  Of course, you expect it to be honored.  Instead, shortly thereafter, you are contacted by an insurance adjuster, not your agent.  Unlike your agent, the insurance adjuster is hostile; the questions he asks imply that you are malingering and have submitted a fraudulent claim.  You try to be cooperative, providing the insurance adjuster with the additional information he requests, but again your claim is denied.  Adding insult to injury, you learn from the adjuster that the insurance company has secretly videotaped your activities and, based on the tapes, believes that you are not disabled at all.  Dumbfounded by the insurance company=s response, you ask yourself if there is anything that you can do to make the insurance company pay the benefits it promised.  The answer is yes.

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Which Type of Disability Insurance Policy Do You Own?

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Disability insurance policies come in several types. The type of policy you purchase affects your legal rights and the benefits you may receive. Here is an overview of the basic types of disability insurance policies.

Individual Disability Insurance:

As the name suggests, individual disability insurance policies are sold directly to individuals from the insurance company. They provide long-term disability benefits in the event of a disabling injury or illness. These policies are further divided into two categories: General and occupational. General policies insure against injury or illness that prevents the insured from performing all work; occupational policies provide benefits only if the insured cannot perform the material and substantial duties of his or her own occupation. An occupational policy provides greater benefits to the insured, who is entitled to benefits even if he or she is still able to perform work in another occupation. These policies provide fixed dollar amounts of coverage, such as $4,000 or $10,000 per month, instead of a percentage of the insured’s salary.

Group Disability Insurance:

Group disability insurance policies, as their name indicates, are sold through groups. Typically organizations, such as the AMA, will set up and make available these policies to their members. These policies usually provide variable amounts of coverage expressed as a percentage of the insured’s base salary, typically from 50-75%. Benefits may also be capped at a maximum fixed dollar amount (e.g. $7,000 per month) regardless of salary. Lastly, these policies often contain offsetting provisions which reduce benefits by the amount the insured receives from other sources such as Social Security or worker’s compensation.

Employer-Sponsored Disability Insurance:

Employer-sponsored disability insurance policies are provided through corporate employment and are both the least expensive policies and provide the least protection for insureds. They are similar to the group policies in that their benefits are a percentage of salary, but they are governed by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA removes many of the protections of state law such as the right to a trial by jury and the potential for punitive damages if the insurer has acted in bad faith.

Ed Comitz and the disability insurance attorneys at Comitz | Beethe protect the disability insurance benefits of physicians and healthcare professionals nationwide. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.


Phoenix Mayor’s Commission on Disability Issues

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On the fourth Wednesday of every month, the City of Phoenix Mayor’s Commission on Disability Issues meets at 4:15 PM in Room 704 of the Calvin C. Goode Building, 251 W. Washington Street, 7th floor. Meetings are open to the public. The Commission is a twenty-one member group of volunteer citizens appointed by the mayor and city council who have interest and expertise in the concerns of the disabled. The Commission seeks to achieve equality for the disabled within Phoenix.

More information is available at the City of Phoenix’s website.


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