Dentists, orthodontists, endodontists, and other dental professionals often purchase long-term disability (LTD) insurance as a safety net. Many of these providers have built thriving businesses, and they know that an unexpected illness, injury, or disability can endanger everything they’ve worked for.
However, you may be surprised to discover that dentists, like many other professionals, have a hard time getting the disability insurance benefits they deserve. At Bryant Legal Group, we represent dentists and other medical professionals in their ERISA and private disability insurance claims. Here, we outline some important factors you need to consider as you prepare your LTD claim.
Dentists Have a High Risk of Disability
Most people don’t appreciate the physical demands of dentistry. Studies suggest that dental professionals have a one in four likelihood of filing for disability insurance during their careers. Cardiovascular disease is the #1 culprit, but there are other factors at play. Years of sustained standing, twisting, stooping, gripping, and grasping can cause degenerative changes in your hands, arms, shoulders, and back. In a 2015 study, more than 68% of the surveyed dentists reported ongoing neck, back, knee, shoulder, or arm pain.
Additionally, mental health issues are common among dental professionals. Dentistry is a high-stress profession, and many providers report ongoing problems with depression and anxiety. Sadly, dentists are twice as likely to attempt suicide than the general population, and three times as likely as most other professionals.
What Is Long-Term Disability Insurance?
LTD coverage pays a monthly benefit if you meet the policy’s definition of disability. Unlike Social Security disability, which is a federal benefits program, long-term disability insurance plans are sold by for-profit insurance companies. Dentists and dental professionals may either get this coverage from their employer or privately purchase it from an insurance agent or a professional organization. (Both the American Dental Association (ADA) and Illinois Dental Society partner with insurance agencies that offer these policies.)
Many dental professionals invest in long-term disability insurance. As a small business owner, you may be painfully aware that an unexpected disability could financially ruin you, especially if you have outstanding dental school debt, business loans, and other obligations. Long-term disability insurance can give you peace of mind.
However, to get that monthly income, you’ll need to file a claim, provide evidence that documents your disability, and meet other requirements. Before you start this process, it’s a good idea to spend some time reviewing your disability plan and building a comprehensive strategy for your claim.
1. Determine Whether Your LTD Policy Is Private or Employer-Sponsored
Different rules apply to your long-term disability claim depending on whether it was privately purchased or employer-sponsored. A federal law, ERISA (Employee Retirement Income Security Act of 1974), covers most group disability insurance plans. If you have an ERISA claim, you’ll need to comply with a strict set of procedures and regulations.
However, if you purchased your LTD policy directly from the American Dental Association or an insurance company, state laws apply to your claim. In this case, you can file a lawsuit more quickly, present additional evidence at trial, and demand a jury trial.
Typically, your Plan Document or Summary Plan Description should outline which laws apply to your claims. You can request these documents from your insurance company. However, if you’re unsure whether you have a private or group disability insurance policy, it’s best to consult an experienced disability lawyer. When you meet with an attorney from Bryant Legal Group, we can help you interpret your Plan Document and explain your legal options.
2. Understand the Precise Terms and Conditions of Your Long-Term Disability Policy
In addition to identifying which laws apply to your claim, your SPD and Plan Document also contain essential terms and conditions that will impact your claim. They typically include:
- Definition of disability: Your policy may pay disability benefits if you’re unable to perform your own occupation. However, most policies only consider you disabled if you’re unable to do any work.
- Limitations: Most policies limit benefits for mental health issues, self-reported conditions, and substance abuse. Typically, your benefits will end after two years if your only disabling condition falls into one of these limitations.
- Exclusions: Some policies will not cover specific medical conditions, self-inflicted injuries, or injuries related to a crime or conflict.
- Filing and appeal deadlines: You’ll need to meet the exact deadlines in your policy if you want your benefits.
A single mistake or missed deadline can lead to a denial of benefits. Again, if you need help interpreting your policy, contact a disability insurance lawyer.
3. Look Out For Dual Occupation Defenses
As a dental professional, you may play many roles in your business: caring for your patients, managing your employees, evaluating the business’ finances, and engaging in long-term planning. You may even have other ventures, dabbling in real estate or property management. Sometimes, insurance companies will try to use your diverse job description against you.
In the “dual occupation defense,” insurance companies argue that while you may be unable to practice the art and science of dentistry, you are still capable of doing your other occupations (like managing your business).
For example, suppose you purchased an “own occupation” policy years ago. Since then, your practice has thrived. You now have offices in four locations, manage a large team of dentists and dental hygienists, and only treat a handful of your old patients.
During a car accident, you suffer a herniated disc in your neck that limits your ability to grip, grasp, reach, and perform essential dental services. Your doctor suggests you file for long-term disability. The insurance company quickly denies your claim, arguing that the bulk of your work has little to do with dentistry and that you can still perform your managerial work.
To fight back, you’ll need strong evidence documenting your physical capabilities, job requirements, and other information. Your disability insurance lawyer will likely consult with vocational experts and physicians to help document how your neck injury prevents you from performing your actual job duties.
- Related Article: What Is Insurance Bad Faith?
Bryant Legal Group: Fighting for Dental Professionals in Illinois
Dentists and other dental professionals face unique challenges in their long-term disability claims. If you have questions about your legal options, contact Bryant Legal Group today. Our Chicago-based legal team assists professionals throughout Illinois with their complex disability insurance claims. We offer free evaluations and can use video conferencing tools to help you maintain social distancing and stay safe.
To schedule your initial consultation with our team, call us at 312-667-2536 or use our online form.