Many issues are particular to chiropractic disability insurance claims. Of all medical professions, chiropractors rank among the highest for filing claims for long term disability benefits.
After years of bending, lifting, adjusting and manipulating patients’ spines and extremities, you may sustain injury to the hands, back or neck. Even “minor” injuries can stop you from practicing as a Doctor of Chiropractic. For these and many other reasons, you protect yourself by purchasing disability insurance. You may also have disability benefits through a group plan or a professional association
But when the time comes to file a claim, there is no guarantee you will be awarded the benefits you expect. Chiropractor’s disability insurance claims are costly for insurance carriers to honor. Sometimes, the incentive for insurers to deny these high payout claims overrides their good faith duty to pay. Many chiropractors’ clams end up unreasonably denied when they are most in need.
We all too often see this in our practice and have extensive experience which such cases. If this has happened to you, the doctor disability lawyers of Marc Whitehead & Associates are here to assist in your fight to receive the benefits you deserve.
What Issues are Specific to Chiropractic Disability Insurance Denial?
A DC’s routine practice is physically and mentally demanding. Manipulating a patient’s spine and musculoskeletal system involves considerable use of the hands, fingers, wrists, arms, legs and back, moving and leveraging his or her entire body, in physical movements simulating climbing, lifting, balancing, walking, stooping, and handling objects and equipment.
The insurance company will often conduct a vocational review to establish their own interpretation of a claimant’s occupational duties and conditions. This typically involves accessing the Dictionary of Occupational Titles (DOT).
The DOT defines the chiropractor’s exertion level as Medium, wherein the physical demand requirements exceed those for Light Work, and involves “exerting 20 to 50 pounds of force occasionally, or 10 to 25 pounds of force frequently, or an amount greater than negligible and up to 10 pounds constantly to move objects.”
Keep in mind these general occupational descriptions may be used in ways that serve the insurer, not the insured. They may not reflect the true extent of duties and specialties performed on a daily basis by the claimant.
Reason for the Denials of Chiropractic Disability Insurance
Recognizing denial tactics, understanding complex insurance policy language, and strategically preparing the material needed to prove disability are vital to successfully appealing a chiropractor’s disability insurance claim denial.
Examples of common insurance denial tactics adopted by various insurance companies include:
Redefining the Chiropractor’s Duties:
If you bought an “own occupation” chiropractic disability insurance policy, you did so to ensure you can get full disability benefits if you become disabled from performing your own specific occupation. Be aware of an insurer’s attempts to claim that you are also, for example, a contributor of chiropractic articles to medical journals. They may claim you are not totally disabled because you can still perform your own duties as an author.
Medical File Reviews:
Insurance companies have in-house medical staff who will examine your medical records and information. Our doctor disability claim lawyers have seen numerous cases where these reviews were done in a manner to channel the case towards denial. Other times, a medical reviewer might never see all of the disabled chiropractor’s medical records – as though the claims handler selectively sent only certain records for review. The reality is that you may have to fight to make sure your complete medical records are given due process.
ERISA Traps
Group disability policies are governed by ERISA law, under which no penalties are in place when companies unfairly deny or delay claims. In an ERISA claim, insurers have nothing to lose by denying benefits. They are essentially immune from liability if they wrongly deny a claim because they are not held to account through “punitive damage” awards or other legal actions.
If you win your benefits in litigation – a lengthy process – the court would award the disability payments you are due – but nothing more. The insurer loses only time and expense of court, whereas the claimant stands to lose much more.
Appeal Bad Faith Denials of Chiropractic Disability Insurance Claims
Some insurers have become masters at denying legitimate disability claims submitted by chiropractors. These powerful companies are supposed to deal fairly and honestly with their policyholders and it is our job as doctor disability claim denial attorneys to ensure that they do.
Our law firm represents medical professionals in all phases of disability insurance claims and cases. Dial 800.562.9830 to schedule a case evaluation at no cost and without obligation, and review our free resources to educate yourself about your rights and possible options.