Chiropractor Disability Insurance Claims

Over many years, we have seen many physically demanding medical occupations become our largest client population.  Chiropractors are among the medical professionals who are more likely to suffer a disability because of the physical nature of their practice. They use their own bodies to exert pressure on patients, in highly specific ways. The chiropractor treats pain in the back, neck, shoulders and hips and any other disorder the patient and chiropractor feels is related to the spine or nervous system.

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Most chiropractors pay careful attention to their own health because they recognize the importance of maintaining strength and flexibility to be effective in their practice. The chiropractor’s body is their medical instrument. They must be strong enough to exert precise motions as well as maintain and control their own stability. Over time, even the strongest, most fit chiropractor, can suffer a disability of their own.  The repetitive nature of the forces applied, over time, cause injuries to these professionals, often leaving them with no choice but to pursue disability, under a policy of disability insurance they purchased years ago, hoping never to need it.

Why Would a Disability Insurance Company Deny a Chiropractor’s Claim

Jason Newfield has represented many chiropractors whose long-term disability insurance claims were denied.  He has successfully led many chiropractors through the long term disability insurance claim process, working with many from the outset of the claim to spot issues before they become problems  – essentially preventing a spill, so that a mess never needs to be cleaned up.

He has authored many articles in chiropractic journals, including Chiropractic Economics and American Chiropractic Association News. The articles draw on his experience representing chiropractors who have paid premiums for disability claims and need help getting their rightful benefits.

  • High income earners are always targeted for a denial or termination. It’s not about the claim, but about the potential payout or savings for the insurance company. 
  • Chiropractors younger than 40 should expect their claim to be targeted for a denial. The amount of time the insurance will be paying benefits means the cost will be higher than if a 60 year old files a claim.  The reserves on this type of claim will be large and create an urgency to foreclose the claim.
  • A frequent tactic used by disability insurance companies is to look for the secondary income streams. This is not limited to chiropractic disability claims, but as chiropractors often have secondary businesses, the disability company will want to use this income as evidence the chiropractor has another occupation which they are still able to perform, thereby eluding the “own occupation” provision of the policy.   A residual claim will preclude lifetime benefits under policies that might otherwise pay for lifetime.
  • Disability insurance companies do not consider chiropractic treatment in the same category as medical treatment. If the chiropractor has self-diagnosed their condition and/or is being treated by a chiropractor, expect the disability insurance company to deny the claim or refuse to credit that chiropractor’s opinions. The disability insurance policy often requires the use of an M.D. and Western medicine, even if it goes against everything the chiropractor personally and professionally stands for.  Ensuring receipt of appropriate care and treatment is critical to a claim’s success.


Why Chiropractors Misjudge Handling of Disability Insurance Claims

Health insurance claims are totally different than long term (or short term) disability insurance claims. Many chiropractors make the mistake of treating their disability claim as if it is just another health insurance claim that they submit in their practices.   The cost of a long-term disability claim to an insurance company needs to be considered when preparing for a claim. The chiropractor preparing the claim should also consider the value of the claim over the course of their lifetime. 

Materials submitted as part of a disability claim have to be viewed in two aspects: the claim itself, and any future appeal or litigation. Medical and financial information provided to the claims adjusters will be reviewed with an eye to denying the claim, seeking inconsistencies in the paperwork, looking for evidence the person may not be as disabled as they claim, or finding some reason to deny the claim based on the medical reports or treating physician’s notes.

While the chiropractor may be ill-prepared to submit a claim, they are even less prepared to go up against a giant insurance company whose only potential loss is a small percent of the cost of maintaining the small army of lawyers, doctors, nurses, and investigators on the insurance company’s payroll. 

For the chiropractor, or in fact any claimant, the risk of a financial disaster accompanying a disability is far more significant. 

Following is a success story from the representation of a chiropractor:

While in private practice as a Doctor of Chiropractic, the realization that the incidence of disability resulting in the inability to work and earn income was greater than dying. As such, it was important to protect myself in case of my own misfortune of not being able to practice, help others and be paid for my services. As luck would have it, after 25 years of practice I developed debilitating symptomatology which was confirmed by objective tests-in a nutshell I was unable to continue practicing my profession. Knowing full well insurance companies use any and every opportunity to deny a claim, I decided to be proactive and hire a specialist in disability insurance claims. After performing my own research and asking for recommendations, I contacted Jason Newfield, Esq. This was by far the best decision I could have made. My first meeting with Mr. Newfield went well and set aside any fear, trepidation or cynicism I may have had preceding my meeting with any attorney. Having been in practice for years, I have had heard and witnessed my fair share of horror stories of self serving attorneys who win at the expense of their clients, but not vise-a-versa. Mr. Newfield clearly laid out my options of what he could and would do for me; financial considerations, potential pitfalls and challenges, costs incurred, etc. He assured me I would have access to him and his staff and he proved to be proactive, forthcoming and competent every step of the way. After reviewing my policies, he knew what I was eligible to claim and maximized the terms of my policies. He exceeded my expectations of financial reimbursement by what was rightfully mine by contract and ensured I received my full benefits from my insurance carrier. Hiring Mr. Newfield was the best and smartest decision I made. He ensured the entire process was seamless vs. a potential hardship.

Why Having an “Own Occupation” Disability Policy Isn’t a Guarantee to Get Paid

The complementary businesses included in most chiropractic practices are great for their patients—a trusted nutritionist, massage therapist, etc.— means patients know they can turn to the chiropractor for solid recommendations if they need other services to maintain or improve their health. But these additional income streams can have a negative impact on the chiropractor’s disability claim, depending upon a number of factors.

Own occupation is specific to your profession as a chiropractor. The success of your claim requires you to prove that you are unable to perform the material tasks and duties of your specific occupation to qualify for benefits under your disability policy. The own occupation may be included in the policy or it may be attached as an own occupation rider supplementing the plan.   Most policies define own occupation as “the occupation” or “occupations” you are regularly engaged in at the time of disability.    Thus, your regular occupation will be the one you are performing at the time of the onset of the disability, not the one you performed at the time when you purchased the policy, or policies if that is the case.  Further, the disability insurance company is looking to see if you meet the highly specific requirements in your plan because of illness or injury.

You should be able to be paid the full monthly benefit for the full benefit period even if you are able to earn income in another capacity during that time if you are deemed disabled from your own occupation.  This is something insurance companies use to terminate benefits, so you should speak with an experienced disability insurance attorney if you contemplate working while on claim.

All disability policies are different, and language will vary, however, so you will need to read your policy to see if the definition of disability means you are not able to engage in any other gainful occupation. If so, you may not have a true own occupation policy, and working in any other capacity will be used to terminate your claim, or otherwise limit benefits.

Some policies offer own occupation disability insurance coverage for a period of time, and then replace own occupation with an any occupation definition after 24 or 60 months. This is often when the claim is terminated as the insurance company maintains you are no longer unable to work because you no longer have own occupation coverage.  Chiropractors are less frequently seen with this coverage, as they often have higher quality own occupation policies, for which rich premiums have been paid for many years.

Jason Newfield has successfully represented many chiropractors at many different stages of their claims. If you have questions about how your disability claim is being handled, or if your claim has been denied, call us.

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