North Texas Dentistry Volume 7 Issue 5 NTD 2017 ISSUE 5 DE | Page 18

insurance update
Filing a Disability
Insurance Claim
What Every Dentist Must Know
by Marc Whitehead, Esq.
Like most professionals, you purchased a long term disability
(LTD) insurance policy to protect yourself in the event of total
or partial disability. But many valid disability claims, even those
made to reputable insurance companies, are denied. Just as dev-
astating, many who are on claim have their benefits terminated
because the insurer decides the claimant is no longer disabled.
The Trend to Deny Legitimate Dentists’ Claims
The disability insurance industry often uses denial tactics for
financial gain. One trend is to deny high payout claims. Dollar-
wise, claim amounts in dentists’ disability cases are consider-
able. From the insurance company’s standpoint, they stand to
profit by denying good claims in bad faith – even if they wind
up in a court battle, even if they are forced to pay damages.
If an insurer has one hundred LTD claims filed by dental pro-
fessionals to pay on, and it succeeds at denying fifty of them,
that equates to millions of dollars they do not have to pay. Some
insurance companies would much rather risk being challenged
by denying the claim, causing delays until the claimant gives up,
or otherwise greatly underpaying or reducing the benefit cov-
erage time.
If an insurance company denies your claim for long term dis-
ability benefits, you can appeal the decision. This is your right,
and the insurer must allow you recourse to a full and fair review
of a denied claim.
How to Prevail? The Devil is in the Details of Your Policy
Filing a long term disability claim is far more than filling out
forms. To protect yourself from a denial of vital benefits, your
claim must be fully developed with medical, vocational and eco-
nomic evidence to:
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demonstrate you are disabled according to the terms of
your policy
prove the economics of your case by showing loss
of earnings
stand up in court and set a solid foundation for a
credible, successful appeal if needed.
18 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
In every case, your claim will be based upon:
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the law that governs your disability claim
your policy’s language, terms and definitions
What Laws Govern Your Disability Claim?
There are two basic types of disability coverage: Individual and
Group. Essentially you may have:
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Individual disability insurance – you purchased the
policy privately
Group disability insurance provided by your employer
Dental association group disability coverage
A hybrid of group and private coverage
The laws regulating individual vs. group disability
insurance are worlds apart.
Individual / Private Disability Claims
Individual disability insurance (IDI) policies are contracts be-
tween you and the insurance company. Policy disputes and
claim denials are governed by state insurance, contract and
bad faith laws.
When an acceptable settlement with an insurance company
cannot be reached, litigation becomes necessary. Litigation of
private policies take place before a jury of your peers. Various
remedies may be available to help you keep your insurer honest
and to fight back against illegal denial practices. State protec-
tions may include suing for:
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n loss of credit claims
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emotional distress
punitive damages
tortious interference with contract
statutory insurance violation claims
deceptive trade acts or unfair practices
prejudgment interest for breach of contract
mandatory attorney fee reimbursement
special damages