Prescription For Doctors

Doctors have more problems with disability income insurance claims than most other occupations, because:

 * They never read their disability policy until they have to make a claim. * Policy benefits are usually higher because they make more money.

 * They are too busy to change coverage when their situation changes.

 * Their duties as physicians are more likely to change because of specialization or increase in skills.

 * The terms of their policy are so complex that they don't truly understand them.

This medical profession problem was succinctly pointed out by T Keith Mangrum of Medical Group Insurance Services, Inc., click here, when she pointed out 10 things a doctor doesn't want to hear when making a claim, in an article in MD Preferred,click here, an online publication for physicians. While the article dealt well with the front end of the MD disability claims process, it did not deal with the back end, i.e., what does a doctor do when faced with a denial of a legitimate disability benefits claim?

As we have said many times before, disability insurance companies have a litany of "reasons" why they should not pay benefits. Some of these reasons have a foundation in law and some do not. Since the policy is the contract which governs the insurance relationship, it is the law of the claim and dictates the rights of the doctor to receive benefits and the insurance company to refuse to pay.

So, the first thing every doctor should do is READ THE DISABILITY INCOME POLICY NOW!!! Doctors, of all people, are aware that illness or injury can strike without warning, at any time of the day or night. No one is immune to catastrophe. After reading the policy, if the full meaning isn't clear, get someone who knows, like a knowledgeable lawyer, to help you understand.

Once disaster strikes, the doctor is stuck with the terms of the policy and can't change them. If the policy doesn't afford enough coverage there's nothing to be done about it. Reading and understanding the policy before the doctor has to make a claim should help take care of the front end. What about the back end - if there is a denial?

As we have pointed out here so many times, insurance companies are adept and motivated to throw roadblocks in the path of benefits seekers even when their reasons for denying a claim sometimes border on the ridiculous. Insurers do so because they know a certain percentage of claimants will give up and allow the insurer to drop what they should have paid in benefits to the company's bottom line.

The stakes in a physician's disability income insurance policy are usually high and give the insurance company more reason to contest the claim. Before a doctor gives up on such a claim it must be absolutely clear that the claim denial is legitimate .

This goes double when the claim is covered by a group policy, purchased by an employer, of which the physician has no firsthand knowledge. To have the policy explained to the doctor by a Human Resources manager who works for the employer and who has no legal understanding of arcane ERISA insurance law and the sometimes questionable tactics of insurance companies, may not be the best thing for the policyholder. So, what is the best thing?

First, read and completely understand the disability income policy. Does the protection it affords them and their family do the job? If not, they should make the desired changes before disaster strikes. And, if they ever should be so unfortunate as to have to make a claim for disability benefits, they definitely should not take an insurer's claim denial as gospel. It is in insurance company genes to almost automatically reply to a claim with a denial, hoping the claimant will "wimp" out and go away.

Doctors know medicine, but they are not experts in insurance law and claims. Don't stand alone. Get a veteran, knowledgeable disability claims lawyer to review your situation and give you an opinion on the validity of the denial.

Only then can the doctor make an intelligent diagnosis of a disability income benefits claim.

A Simple "Thank You"

Because of a relatively few bad apples, the vast majority of lawyers have a mostly undeserved rep with the public.

Lawyer jokes abound and lawyers’ friends are only too happy to share the latest one with their pals who are members of the bar. Such conduct on the part of our friends doesn’t bother us one whit. We know that with all of this laughing and “hoo-hawing”, the first person these seemingly disdainful friends call when there is a serious problem of any kind is the butt of their lawyer jokes – us.

It makes it kind of easy for us to bear the jokes when we know that when the chips are down, the “laugher” is going to run “crying” to us for help and advice.

The reason we are on this subject at this “up” time of the year is an email we just received from a client, which makes all of the hard work, stress and lawyer jokes worthwhile.

Down through the years, we have come to understand that most clients consider the rule of thumb for lawyers is:

If the lawyer gets a good result, the client considers it is because the client had a peachy case; if there is a poor result it is because the lawyer handled the matter badly.

With this mantra stacked against us, it is really tough to get even a left-handed compliment from a client, no matter what the result.

That’s why we were so pleasantly surprised and delighted when one of our clients, whose matter was resolved in early 2010, thought it appropriate to write us to say “Thank You” in a heartfelt and sincere way. In our experience, it is unusual for a client to see and understand the value of what lawyers do beyond the fees we get paid. It is even more extraordinary when the client feels the need to communicate that feeling to us, especially long after the matter is concluded.

The email was just a few words, but it goes up in our Hall of Fame:

“December 28, 2010

“Dear Mr. Quiat:

“It is the end of the year a time for reflection and giving thanks. I wanted to let you how thankful I am for the services you provided us. I have kept your voice mail on my cell phone, it cheers me up everytime I listen to it. Thanks once again. “Best wishes for a happy, healthy, and prosperous new year. Good luck digging out from the snow!
                                                                    “a very grateful and appreciative client,…”

This matter involved a medical doctor who had an unusual medical problem on top of a particular clause in his policy which would, at first blush, seem to preclude any disability income benefits for him. The solution, which led to full benefits for him, took a close reading of the policy, intense medical research and a clear, well-reasoned appeal to the insurance company.

The fact that the work on his case followed the normal pattern of what we do in matters of this kind did not hide the value to him of what we do. And this doctor felt that what we do requires a THANK YOU even long after the matter was concluded.

Such thoughtfulness touched us deeply and brightens our recollection of the work we did in 2010. For that I thank the doctor from the bottom of my heart. It’s good to know that someone out there really understands what we do.

                                                  A Happy and Healthy New Year To All!!!

 

 

 

 

 


 

 

 

 

 

 

 

 

Figure In The Tax, Too

A recent 3rd Circuit Court of Appeals ruling got us to thinking about the effect of lengthy litigation on an award in disability income cases.

In Eshelman v. Agere Systems, Inc., 554 F. 3rd 426, the appellate court upheld a District Court decision awarding additional damages to the plaintiff’s jury award of $200,000, to cover the added taxes she would have to pay because she received a lump sum award rather than having been paid her salary over a period of years as she would have if she had not been discriminated against.

Well, we reasoned, shouldn’t the same thinking be applied to disability income insurance cases which many insurers cause to be dragged on for years and years when it is apparent to any disinterested observer that the claim should have been paid early on. The insurance company’s reluctance (almost a reflex action when it comes to paying claims) should not cause the disabled policyholder more grief by adding to his or her tax burden.

The circumstances are very similar. When a person loses a position because of the wrongful action of the employer, the person loses the benefit of being paid weekly or monthly and paying income taxes periodically through withholding and annual tax returns.

When an insurer wrongfully drags out the award of benefits to a disabled person, the claimant loses the benefit of being paid these insurance monies weekly or monthly and paying income taxes (if the benefits are taxable) annually. (Generally, disability income benefits are taxable if an employer pays the policy premium and non-taxable if the insured pays the policy premium).

If a disability income case drags on for awhile (some are known to have gone 10 years or more), and results in a lump sum award to make up for the years during which no monies were paid, that lump sum is taxed in the year it is received by the claimant. Many times this puts the recipient in a much higher tax bracket, meaning that a much larger percentage of the award will have to be paid than the claimant would have paid if benefits were received and taxes paid each year.

As a result, the claimant is not made whole, receiving less money in his or her pocket than he or she would have received if paid monthly for the period

We believe it fair that a District Court judge have the discretion to make an additional financial award to make up for the tax difference so as to make the plaintiff whole when appropriate evidence has been elicited to support such a tax award.

 


 

 

 

 

 

 


 

Pull In The Welcome Mat

 

 

 


If an adjustor or other agent of your disability income insurer wants to talk with you as a claimant, talk. But, there is no way you should invite the agent into your home or office. Meet the agent at your lawyer’s office with your lawyer present.

By the very nature of the insurer-claimant relationship, it is obvious the insurer is not your friend. Therefore, neither is the insurer’s employee, the adjustor.

An adjustor may try to charm you into a “convenient” visit to your home just to get “your view” of your claim. Don’t fall for this line. The adjustor works for the insurance company which is trying its “darndest” to reject your claim or at least find some reason for reducing it.

Why host a meeting at your home or office which will give your adversary a leg up on how you live, what you own and how tough an adversary you are likely to be? Also, acting as a “host” you are less likely to carefully scrutinize the statement that the adjustor is likely to write as you talk and ask you to sign.

If the adjustor wants to talk, your policy requires you to cooperate and talk. But, the time and place of the discussion has to be mutually agreed upon.

The best place for such a meeting is your lawyer’s office with your lawyer acting as host.