| April
29, 2005 CHIROPRACTIC ECONOMICS
What to expect if you file a disability
claim
Disability claims for chiropractors are
different from those of most of your patients. Many individuals
may be able to function with cervical, thoracic or lumbar
problems, or at least work in a reduced capacity.
However, a chiropractor can be physically
and financially debilitated if these symptoms become chronic
and affect performance.
Repetitive movements put strain on your
body. Carpal tunnel syndrome and other hand and arm problems
are occupational hazards for chiropractors. You may reach
a point at which you are not effective in treating patients
because of pain. Pushing yourself to do a proper adjustment
can put added stress on injured areas and, over time,
lead to permanent damage.
Sometimes reducing your hours can help,
so that you can continue working on a part-time basis.
In many situations, however, it is necessary to cease
performing manipulations.
Many individual disability policies available
to chiropractors provide partial or total disability benefits,
often to age 65 and sometimes for life. The working is
often occupation-specific, meaning that if you cannot
perform the substantial and material duties of a chiropractor,
the insurance company will pay you the full amount of
the benefit.
Although an insurance company may make
certain promises in the way of a disability contract,
these broadly worded policies sometimes leave a trail
of “red ink” that bring about claim management
practices chiropractors never envisioned at the time of
policy purchase.
To control claims, many insurance companies
use defensive measures that make the claim process difficult.
These measures include field investigations (a personal
visit with you), independent medical evaluations (IMEs),
functional capacity evaluations (FCEs), video surveillance,
forensic audits and a host of others:
Field
Investigation. A field investigation can be done by
appointment or may be unannounced. You may be asked to
read and sign a statement prepared by the investigator.
Read it carefully at another time and return it to the
investigator with appropriate corrections.
IMEs
and FCEs. IMEs are performed with most claims even
when the claimant’s symptoms can be verified by
the attending physician. Insurers now use FCEs more frequently,
with claims related to musculoskeletal and hand and arm
problems.
Surveillance.
Video surveillance is used to determine whether your medical
symptoms are in conflict with your lifestyle. Insurers
closely monitor athletic and social activities early in
the life of a claim and can do so repeatedly until the
claim is settled.
CPAs.
Insurers frequently use forensic CPAs (accountants) on
partial disability claims to dispute the pre- and post-disability
earnings figures provided by the claimant. A compromise
may be necessary to arrive at a figure acceptable to both
parties.
Note: Do not discuss over the telephone
any calculations related to financials. Instead, ask the
insurance company to send you a written list of questions,
which your accountant can review. The CPAs for both sides
can then discuss the issues.
How you submit a disability claim on paper
and how you behave in your personal life can determine
whether your receive a settlement. Most physicians do
not know the difference between a workers’ compensations
claim, a Social Security disability claim and your personal
or overhead disability policy(s).
Your attending physician my need help
with the policy language and the meaning of some questions
on the attending physician statement. Although scarce,
disability claim consultants can provide help in the various
aspects of your disability claim so that you and your
treating physicians do not make any mistakes.
_____________________________________________________________
Art
Fries is a disability claim consultant providing advice
nationwide. He is located in Newport Beach, Calif. To
learn more about disability claims, call 800-567-1911
or visit www.afries.com
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