As a dentist, you know the importance of protecting your health and your income. You work hard to provide quality dental care to your patients, but what if you become unable to work due to an illness or injury? How would you cope with the loss of income and the potential impact on your practice?
That's where disability insurance comes in. Disability insurance is a type of insurance that pays you a percentage of your income if you are disabled and unable to work. Short and long term disability benefits can help you cover your personal and business expenses, maintain your lifestyle, and protect your family’s financial security.
Below we’ll answer common questions dentists have about short and long term disability insurance.
What Is the Difference Between Short Term and Long Term Disability Insurance?
Short Term Disability (“STD”) and Long Term Disability (“LTD”) insurance are designed to provide financial support if you are unable to work due to a disability, but they differ in several key ways:
Duration: STD typically covers a period from a few weeks up to one year, whereas LTD can extend from a few years up to retirement age, depending on the policy.
Waiting Period: The waiting period for STD is usually short, ranging from 0 to 14 days. LTD has a longer waiting period before benefits begin, typically ranging from 90 days to 180 days.
Benefit Amount: STD generally provides a higher percentage of income replacement, often around 60% to 80% of your pre-disability earnings, while LTD usually replaces about 50% to 70% of your pre-disability earnings.
For dentists, these differences are crucial as the nature of their work requires precision and can be physically demanding. STD might cover temporary conditions such as surgical recovery or acute medical conditions, while LTD is essential for more severe and long-lasting health issues that could permanently impact your ability to practice.
How Do Group and Individual Disability Policies Differ for Dentists?
Group and individual disability policies differ mainly in terms of who purchases the policy, the cost, the coverage specifics, and under what conditions you can receive benefits. Dentists, like other professionals, can opt for either or both types of policies depending on their needs and circumstances.
Group Disability Policies are:
Typically provided by an employer or professional association and often part of an employment benefits package.
Generally less expensive for the insured since the employer often shares or covers the premium costs, and the risk is spread across all the members of the group.
The benefits might be less tailored to the specific needs of dentists and could be more restrictive with lower benefit caps and shorter benefit durations.
Individual Disability Policies are:
Bought by individuals directly from an insurance company.
More expensive as the individual bears the full cost of the premium, but this type often offers more comprehensive coverage.
Provides more flexibility in terms of coverage options and benefit periods, which can be tailored to the specific needs and risks associated with a dental practice.
Dentists can indeed have both group and individual disability policies. Holding both types of policies can provide broader protection and higher benefit coverage, particularly useful in professions like dentistry where the risk of occupational injury or illness affecting your ability to work can be significant.
How Do Dentists Qualify for Short or Long Term Disability?
To qualify for disability insurance benefits, dentists must meet certain criteria defined under their specific policy’s terms. The key definitions of disability in disability insurance policies that affect dentists include “own occupation” and “any occupation,” along with variations that can significantly impact how benefits are determined.
Common definitions of disabilities found in policies include:
Own Occupation: This definition is crucial for dentists. It states that you are considered disabled if you are unable to perform the duties of your specific occupation as a dentist due to an illness or injury. This is particularly important because the precise and demanding nature of dental work means that even slight impairments can prevent effective practice. Under an “own occupation” policy, a dentist who can no longer perform dental procedures due to a physical condition like hand tremors, but can still work in another capacity, would still be eligible for benefits.
Any Occupation: Under this definition, disability benefits are only provided if you are unable to work in any occupation for which you are suited by education, experience, and age. This is generally stricter and can significantly impact dentists because, despite a disability that prevents them from practicing dentistry, they might still be able to work in other fields such as dental education or consultancy. Thus, benefits might not be granted if they are capable of engaging in these other roles.
Hybrid: Some policies combine these definitions or apply them in stages—initially offering “own occupation” protection that transitions to “any occupation” after a certain period (typically two years). This affects dentists by initially providing broader coverage that narrows over time, potentially reducing or terminating benefits as the policy conditions change.
Understanding these definitions helps dentists anticipate how their ability to claim and retain benefits might be influenced by their specific medical circumstances and the nature of their work. It’s vital for dentists to carefully review how these definitions are framed in their policies to ensure adequate coverage aligned with the risks inherent in their profession.
How Can Dentists Effectively Document Their Disability?
Dentists can effectively document their disability by compiling a comprehensive set of evidence that supports their claim. This documentation should include both medical and vocational evidence as well as personal accounts that together build a strong case for your disability insurance claim.
Here are common types of evidence you can use to support your short or long term disability claim:
Objective Medical Evidence: This includes medical records, lab test results, imaging studies (like X-rays, MRIs, or CT scans), and any other quantifiable data that can demonstrate the presence and extent of a medical condition. For dentists, objective evidence could also involve specific tests that show limitations in manual dexterity or motor skills, which are essential in their profession.
Subjective Medical Evidence: This type of evidence includes medical opinions, diagnostic reports, and treatment notes from healthcare providers that describe the symptoms and limitations experienced by the dentist. While subjective, these reports are critical as they provide context to the objective findings and outline how the symptoms affect daily functions.
Functional Capacity Evaluations (“FCE”): These are comprehensive tests conducted by occupational therapists or physical therapists to assess your functional abilities with respect to a variety of physical tasks. An FCE can demonstrate your physical limitations, especially those that impact your ability to perform specific job-related tasks, such as handling tools and standing for extended periods of time.
Neuropsychological Evaluations: These evaluations are important when your disability involves cognitive or psychological components, such as memory issues, concentration problems, or other mental impairments that could affect your ability to practice dentistry effectively.
Vocational Evidence: This type of evidence evaluates the dentist’s training, skills, and education in relation to their ability to perform their job or any job, depending on the policy’s definition of disability. It helps illustrate the unique impact of the disability on their specific occupational duties. This can include a vocational assessment by a vocational expert, your resume, official job description, and performance reviews reflecting a decline in performance since the onset of your medical condition.
Personal Affidavits and Witness Statements: A personal statement detailing how your daily life and work capabilities as a dentist are affected by your condition can help support and substantiate your medical and vocational evidence. Similarly, statements from colleagues, family members, or friends can support claims about how your disability impacts professional and personal activities.
Symptom Diaries: Keeping a detailed diary that records the frequency and severity of symptoms can be particularly persuasive. For dentists, this might include documenting pain levels, fatigue, and the inability to perform precise tasks needed in dental procedures.
Collectively, these forms of evidence provide a multidimensional view of your disability. It’s crucial for dentists to gather this evidence methodically and from the onset of their disability to ensure all aspects of their condition are well-documented and robustly supported. This approach increases the likelihood of a successful disability claim.
Why Are Disability Claims by Dentists Commonly Denied?
Disability claims by dentists are commonly denied due to several reasons that often relate to the specifics of their profession and the nature of their insurance policies. Understanding these reasons can help dentists better prepare their claims to minimize the risk of denial.
Common reasons for short or long term disability denials for dentists include:
Insufficient Documentation: One of the most common reasons for denial is the lack of adequate medical evidence that confirms a disability. Because dentists typically have deep medical knowledge, some may forgo visits with physicians, leading to a lack of documentation of their conditions, symptoms, and treatments. Dentists must provide comprehensive documentation, including both objective and subjective medical evidence, to support their claims. Failure to do so can result in a denial.
Discrepancies in Medical Information: If there are inconsistencies between a dentist’s reported symptoms and the findings from medical examinations and tests, insurance companies may doubt the legitimacy of the claim. It’s crucial for all records to be consistent and accurately reflect your condition and symptoms.
Definition of Disability: The specific definition of disability in your insurance policy plays a significant role in how your insurance company evaluates your claim. Many dentist policies are based on an “own occupation” definition. This means your evidence must demonstrate that your condition prevents you from performing your occupational duties as a dentist. If your insurance company determines you can still perform the material functions of your job, they may deny the claim.
Pre-existing Conditions: Some policies have exclusions for pre-existing conditions. If your insurance company determines that your disability stems from a condition that existed before the policy was purchased, they may deny the claim based on these terms.
Non-disclosure: Failure to disclose previous health issues or other relevant information at the time of application can lead to denials. Insurance companies might consider this non-disclosure as a breach of the policy’s terms.
Surveillance and Social Media: Insurance companies sometimes use surveillance tactics or review public social media profiles to find evidence that a claimant may not be as disabled as they claim. For dentists, physical activities depicted in videos or photos can contradict claims of physical disability.
Failure to Follow Treatment Plans: Seeking appropriate treatment is a requirement of most disability insurance policies. If you do not follow prescribed treatment plans or fail to attend medical appointments, your insurance company may argue that you are not sufficiently attempting to mitigate your condition and are therefore noncompliant with the policy terms, leading to claim denial.
Understanding these potential pitfalls can help dentists navigate the claims process more effectively, ensuring all necessary documentation and precautions are in place to support a robust claim.
What Steps Should I Take If My Short or Long Term Disability Claim Is Denied?
If your disability claim is initially denied, there are several important steps you should take to prepare for an administrative appeal, especially under policies governed by the Employee Retirement Income Security Act (“ERISA”), which covers most group disability policies provided by employers.
Here are a few steps you can take in the event of a disability insurance claim denial:
Review the Denial Letter: The first step is to carefully review the denial letter sent by your insurance company. This letter should explain why your short or long term disability claim was denied and provide information on the appeal process, including the deadline for filing an appeal. Understanding the reasons for denial will guide your next steps.
Note Deadlines: Under ERISA, you typically have 180 days from the receipt of the denial letter to file an appeal for a long term disability claim denial. This deadline is crucial because missing it can forfeit your right to further challenge the decision. Mark this deadline prominently in your calendar and plan your actions accordingly.
Request the Claim File: You have the right to request a complete copy of your claim file from your insurance company. This file includes all the documents and records your insurance company used in making their decision to deny your claim. Reviewing this file is essential to understand the basis of the denial and to address specific issues in your appeal.
Contact an Attorney: Given the complexity of ERISA regulations and the high stakes involved, contacting an attorney who specializes in disability insurance claims is advisable. An experienced long term disability attorney can help interpret the denial letter, gather additional evidence, and draft a compelling appeal. They can ensure that all procedural requirements are met and that your appeal is as strong as possible.
The administrative appeal under ERISA is often the last opportunity to add new information to your claim file, as subsequent challenges in court will only review the evidence presented during the initial claim and the administrative appeal. Therefore, the appeal process is crucial and typically represents the final chance to resolve the issue without resorting to costly and time-consuming litigation.
Taking these steps diligently will prepare you effectively for the appeals process and increase the chances of overturning the denial of your disability claim.
How Can The Maddox Firm Prove My Short or Long Term Disability Claim?
At The Maddox Firm, we specialize in supporting professionals like dentists through the often complex process of filing and proving short or long term disability claims. Our expert team understands the unique challenges faced by dentists and employs a comprehensive approach to ensure that your claim is effectively managed and supported from initial filing to potential appeals or litigation.
We Examine Your Policy and Assess Your Claim: We begin by thoroughly reviewing your disability insurance policy to understand the specific coverage and definitions of disability it contains. For dentists, this often involves analyzing the “own occupation” terms that are critical in determining how disabilities that specifically affect your ability to perform dental procedures are handled. We assess your claim against these definitions to ensure all relevant conditions and terms are favorably interpreted for your situation.
We Handle All Communications with Your Insurance Company: Our team takes over all interactions with your insurance company, relieving you of the burden and ensuring that communications are strategically managed. This includes submitting all necessary paperwork, responding to requests for additional information, and negotiating with your insurance company. For dentists, we particularly focus on articulating how specific dental tasks are impacted by your disability, emphasizing the precision and physical demands of your profession.
We Help You Obtain Evidence to Support Your Claim: Gathering robust evidence is crucial, especially for complex dental claims. We guide you in obtaining comprehensive medical records, detailed physician’s statements, and, if necessary, expert opinions that specifically address your ability to perform dentistry. If applicable, we also recommend Functional Capacity Evaluations and neuropsychological evaluations to provide objective data about your physical and cognitive capabilities.
We Handle Appeals and Litigation: If your claim is denied, we are prepared to handle the appeals process, ensuring that all deadlines are met and that your appeal includes all necessary additional evidence and documentation. Should litigation become necessary, our legal team is equipped to represent you in court, leveraging our deep understanding of disability law and the specific challenges faced by dental professionals.
With The Maddox Firm, you have a dedicated ally in navigating the complex landscape of disability claims, ensuring that your rights are protected and your professional needs as a dentist are thoroughly understood and addressed.
A short term disability or long term disability claim can be a complicated process. If you need help during the claims process, with appealing a claim denial, or with litigating a final adverse short term or long term disability decision, The Maddox Firm can help. The experienced team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim. Our New Jersey and New York long term disability attorneys help clients nationwide.