Are you a chiropractor considering applying for long-term disability benefits? Or has the insurance company denied your claim? Are you looking for tips on how to maximize your chances of success? Look no further. This is your guide to winning chiropractor long-term disability claims.
For reasons I will discuss below, chiropractors face additional challenges in long-term disability claims. Insurance companies assign the best people to your case. And by that, I mean they are very skilled at finding ways to deny disability claims.
Whether you are toying with the idea of filing a disability claim, or have an open claim, don’t go any further until you have read this article. You can also download a free copy of my book or schedule a case evaluation with us. Call us at (888)-732-0470 or fill out the form at the end of this article.
Unique Challenges of Chiropractor Long-Term Disability Claims
Chiropractor long-term disability claims have unique challenges. These challenges won’t be apparent unless you have worked on disability claims for chiropractors.
1. Chiropractors often work themselves to complete physical and mental breakdown
Unfortunately, many chiropractors don’t reach out until they have suffered a complete physical and mental breakdown. This is a problem because these extreme breakdowns turn into a crisis. It makes everything about your claim more difficult. And, you are more likely to make mistakes and bad decisions.
Why does this happen? Chiropractic work is both physically and mentally demanding. Every day you are required to perform physically challenging work, and that work is stressful — especially since you are manipulating fragile components of the human body. You may also have the added responsibility of being self-employed. And this means you are less likely to take time off to deal with health issues. Therefore, when you start suffering a disability, things can escalate quickly. Combine all this with a type-A personality, and you have a recipe for disaster. Most chiropractors I have represented have worked themselves to the point of a complete mental breakdown.
Solution:
Start planning early. Create a plan for a successful transition from work to sick leave. Learn as much as you can about your policy’s eligibility requirements for long-term disability benefits. Seek advice from a disability lawyer on when your medical condition and impairments qualify you for long-term disability benefits. Get started now, and download a copy of my book, A Beginner’s Guide to Disability Insurance Claims in Canada. Then, contact us for a free policy review and consultation about your situation. We can help you develop a plan for success as part of our free consultation.
2. Chiropractor long-term disability claims usually involve individual insurance policies (which are more complicated)
Much of what you read about long-term disability claims will not apply to you. Most of the information online relates to group disability insurance policies, but you likely have an individual insurance policy. Your policy is much more complicated. It’s full of ways for insurance companies to deny or limit your benefits. For example, your policy will probably have various definitions of disability and occupation. You will see terms like total disability, partial disability, presumptive disability, regular occupation, own occupation, and gainful occupation. To qualify for disability, you may have to prove that your business income has dropped by a certain percentage. What you say and how you present your case matters. Anyone with an individual insurance policy should seek legal advice before applying for long-term disability benefits.
Solution:
Contact us for a free policy review. We will review your long-term disability insurance policy and explain it to you. We can help you spot potential problem areas. That way, you can know how the insurance company may try to limit your benefits so you can take steps to prevent it. Fill out the form below at the bottom of this article to request a free consultation.
3. Insurance companies will seek to limit your claim by broadening the definition of your “regular occupation”
You buy long-term disability benefits to protect you if you can’t do your “regular occupation” or “own occupation.” Like most chiropractors, you may feel this is straightforward. You are a chiropractor. That is your regular occupation. However, this may not be true, or the insurance company may not see it that way.
Insurance companies will examine your entire practice. Do you sell supplements, medical devices, or other natural remedies? Do you employ other chiropractors, massage therapists, or other health professionals? If so, the insurance company will seek to define your “regular occupation” to include being a business owner or manager. That way, even if you can’t perform the duties of a chiropractor, you still may be able to do some responsibilities of a business owner or selling products. At least on paper. This allows them to deny your claim or fit you under the definition of “partial disability.” This can significantly limit the benefits you can get.
You should be aware of this issue before you apply for long-term disability. Most chiropractors find this out too late. The insurance company will gather your verbal and written statements to support their arguments. You won’t even realize what is happening — until it’s too late. The extent of this risk will depend on the wording of your insurance policy. I encourage you to reach out to us for a free policy review so we can see how this issue may affect your long-term disability claim.
Solution:
You need to learn the right way to describe your work to the insurance company. The best way to do that is to get a disability lawyer review your policy and then apply the definition of “regular” occupation to your practice. The disability lawyer will be able to tell you if it’s possible that your regular occupation could be defined as something in addition to being a chiropractor. If your situation could go either way, then a disability lawyer can help you present your claim in the most favourable way.
4. The insurance company may seek to have your long-term disability policy declared invalid
With individual insurance policies, insurance companies have the opportunity to have the policy declared void. This is a secret tactic most people don’t know about until it is too late. Insurance brokers won’t mention this because they are often part of the problem.
This is how it works. When you bought long-term disability insurance, you had to fill out several forms. These forms have tons of open-ended questions about your medical history. It is easy to answer these quickly without giving them much thought. Sometimes brokers will breeze over these questions failing to explain what they really mean. Once you file a long-term disability claim, the insurance company will order your historical medical records. The insurance company will then compare those records to your answers on those initial forms. They will look for inconsistencies, so they can claim you misrepresented your health when buying the insurance. If they can prove a mispresentation, the court can declare the insurance policy void.
Solution:
Compare your past medical records with the answers you gave on forms you completed when buying the insurance policy. Look for discrepancies or contradictions. Consider getting a lawyer to do this because you may not be objective about your situation. They also know what to look for, while you may not.
5. Chiropractors often get treatment from colleagues or friends
As a health professional, you know and work with other health professionals. Therefore, you are more likely to get treatment from a colleague or friend. While this seems innocent, getting treatment from friends or colleagues creates major problems for your long-term disability claim. The opinions of your treatment providers are likely to be seen as biased because they are your friends. Also, in my experience, treatment from friends and colleagues doesn’t follow usual business practices. It is often done after hours, outside of the clinic, with little or minimal documentation. There may be insurance billing issues, unreported cash payments or in-kind payment. This creates headaches for both you and your friend who provided the treatment. It is critical that you avoid these issues by seeking treatment through normal business practices.
Solution:
This is the easiest mistake to fix. Stop getting treatment from colleagues or friends. Work with independent treatment providers and ensure your treatment goes through their normal procedures and office hours. Make sure your treatment gets documented.
How to Win Chiropractor Long-Term Disability Claims
Start planning early
As a medical professional, you understand impairment and disability better than most people. You can anticipate what conditions may worsen over time. Use this to your advantage and start planning early. There is no shame in planning for the possibility of a sick leave or reducing your workload. The key to planning is knowing your long-term disability policy. Does it allow for partial disability? How impaired must you be to qualify for full-payments? What evidence do you need for your policy? What income loss (if any) will you need to provide to qualify?
Gather strong medical & financial evidence
You’ll need to have your doctors fill out medical forms and reports. However, it is just as important that your treatment providers’ records and documents everything. They should show your medical history, treatment plan, response to treatment, and your willingness to try all possible treatments. In addition to medical records, you may need financial records. These may include timekeeping, billing records, tax returns, and annual corporate financial statements. It’s critical that you have all of these documents in good order before sending them to the insurance company.
Understand your policy requirements
Individual disability insurance policies are complicated. You can’t rely on what you read online because that usually relates to group disability insurance policies. You need to know how your policy defines total disability. Is it based on your inability to perform job duties? Or is it based on the percenatage of earned income lost? You need to know the implications of accepting partial disability opposed to total disability. Partial disability often has a much shorter benefit period. This means you may not have coverage for as long as you think. What does your policy allow regarding attempts to return to work? What about part-time work? These are all things you must know so you can avoid surprises.
Be ready for surveillance
Once you start a long-term disability claim, you should expect the insurance company to put you under surveillance. This won’t be all the time, but can occur for several days at a time. Surveillance is almost certain if you have a high monthly disability payment. It’s also common when your disability is associated with subjective symptoms like pain, fatigue, or depression.
Be prepared to speak with the insurance adjusters
Insurance companies will look for ways to limit or deny payments. A common tactic in chiropractor claims is to try and define your regular occupation as a business owner rather than simply a chiropractor. This way, the insurance can deny your claim even if you can’t do the duties of a chiropractor.
Find out if you are at risk for this tactic as early as possible. You need to know how to describe your business and duties to the insurance adjusters. They will ask questions and suggest answers, hoping you will agree with them. You need to be able to clarify and give the correct response. Once you provide a written or verbal statement favourable to them, it is harder to undo it later. This is because it will look like a lawyer is getting you to change your story, even if what you wanted to say was the truth all along.
Lawyers for Chiropractor Long-term Disability Claims
Resolute Legal Disability Lawyers has experience representing chiropractors in long-term disability claims. We give free consultations and policy reviews to chiropractors at all stages of their claim. We can represent you in preparing your initial application or appeals, and in lawsuits against the insurance company when necessary.
