Dentist Long Term Disability Insurance Claim Tips for Benefit Approval

Dentists have a broad range of job duties, many of which require concentration, steady hands, and the ability to maintain uncomfortable positions for some length of time. When a dentist is no longer able to perform one of these key duties, they may qualify for long term disability benefits; however, seeking out the disability benefits you deserve (and have earned) can sometimes seem like fighting an uphill battle.

Understand the definition of “disability” in your policy. Is it really “own-occupation”?

Although all policies have their own language, the definition of disability in a long term disability policy is typically an “own-occupation” definition. This allows you to receive long term disability benefits if your injury or illness prevents you from performing your own occupation, or the occupation you are performing at the time you became disabled. If you were a dental surgeon, your own occupation is dental surgeon; if you are a periodontist, your own occupation is periodontist. Though this definition can shift over time, being able to establish your disability under an own-occupation definition is the first step in having your long term disability claim approved.

A detailed analysis of your production code reports is required to prove your “material duties.”

Because the procedures dentists perform are codified, it can be fairly easy for your disability insurance carrier to look back at your production code reports to see what constituted the “material duties” of your own occupation at the time you became disabled. But if you, like many dentists, shied away from performing certain procedures during the months or years leading up to your disability, the last couple of years of production code reports may not tell the whole story.

You may have been residually disabled for months or years if you suffered a 20% loss of income.

Depending on when you stopped performing certain dental procedures, your disability may have developed months or even years before you think. If you found yourself turning down work because you couldn’t handle the extra hours or turning down certain procedures because you weren’t physically capable of performing them to the best of your abilities, you may have been suffering from a residual disability. Your disability insurance carrier may ask, “what’s changed?” if you were still scheduling and performing procedures up until the point you filed for long term disability benefits.

Your medical records must document all your medical complaints and limitations.

The long term disability insurance carrier will want copies of all your medical records and will go through these documents with a fine-toothed comb. As a result, it’s important for your medical records to document all your complaints and limitations, particularly if your disability is pain-related. Pain is subjective and doesn’t show up on medical tests the same way other ailments do, so the more objective information your medical record contains, the more likely you are to have your long term disability claim approved.

Your policy may allow you to keep your dental practice running and collect total disability benefits.

Being disabled according to the terms of your policy does not mean you necessarily have to shut down the dental practice you’ve worked hard to build. This issue will turn on your disability insurance policy’s definition of “earnings.” If you bring in another dentist to work for your practice or take other steps to keep your practice running and your long term disability policy doesn’t define “earnings” broadly enough to include money your practice is earning, you may still qualify for total disability benefits even though your practice remains operational.

Business overhead disability policies have very specific language that usually requires you to keep the business “operational.”

Every business overhead policy is written differently, but many dentists’ long term disability insurance policies have “business overhead” coverage. This coverage requires you to keep your dental practice operational, but can provide dentists with additional long term disability benefits to cover certain overhead expenses you need to spend to keep your practice solvent (for example, rent, wages and benefits, or personal protective equipment). Receiving business overhead disability benefits can provide well-earned peace of mind for any dental practice owner who may be unsure about the next steps for your business.

At Dell & Schaefer, we’ve represented dentists all over the country and helped them fight for the long term disability benefits they deserve. We can help you too – and all we’ll need to get started is a copy of your benefit denial letter (if any) and a copy of your policy. If you’d like to talk to an attorney about your options, give a member of our team a call today to set up your free initial consultation.