Chiropractors treat patients when they have pain in their backs, necks, shoulders, and hips, suffer from headaches or other disorders that can be traced to the spine. The chiropractor is a trained and licensed professional who has devoted years of study to how the spine and the nervous system work together to create optimal health. Most chiropractors align their lifestyle with a dedication to the health of their patients and themselves, so it is extremely frustrating when the chiropractor becomes the patient.
The nature of chiropractic medicine requires that the chiropractor be able to use their own bodily strength to manipulate patient’s bodies in specific and skilled ways. The exertion of extremely precise forces by the chiropractor requires strength from their hands through their backs. Stability as well as strength is needed to exert force in a highly controlled manner. A weakened stance can cause real damage to patients. It is a responsibility the chiropractor takes seriously.
Frankel & Newfield has successfully represented many chiropractors in long term disability insurance matters and have published articles in professional journals, including Chiropractic Economics and American Chiropractic Association News that draw on our experience representing chiropractors with long term disability insurance matters. All of the articles discuss the particular challenges facing chiropractors when it comes to filing a claim for disability benefits.
These claim challenges occur for a number of reasons:
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Chiropractic offices deal with health insurance claims on a daily basis, so we often hear from chiropractors who made the mistake of treating their disability claim as if it was a simple, straightforward claim. This is not how disability insurance claims work. The portals created by disability insurance companies are a great convenience, but they are also spring-loaded with problems. Disability insurance claims forms present a veritable minefield of problems for any claimant.
Any information—medical or financial—that is submitted as part of a disability claim must be looked at from the standpoint of a future administrative appeal, litigation, or negotiation. While not every claim ends up in litigation, the claims process is fundamentally concerned with building a case to control the claim. That means gathering information that can be used to deny or terminate a claim.
Another issue facing chiropractors emerges when practice records are requested to evaluate the claim. Because chiropractic treatment is not always covered by insurance, some chiropractors do not use the same diagnostic codes that are central to billing and financial evaluations for most medical offices. Oftentimes, the evaluation of a chiropractor’s production leads to claim challenges.
Disability insurance policies are created to insure “own” or “any” occupations. The “own” occupation policy means that the person’s ability to perform the materials duties of their own occupation is being insured. “Any” occupation policies insure a person’s ability to work in any job. Most high-income professionals, including chiropractors, purchase “own” occupation policies to protect their earnings from their profession.
Here is where it becomes problematic. Many chiropractic practices offer nutritional supplements and the services of complementary providers like a massage therapist, acupuncturist or aromatherapist. The insurance company will question the income that these individuals and product sales contribute to the overall financial structure of the practice. The claims adjuster may categorize the chiropractor as a business manager, not solely a medical provider, and characterize the claim as not total disability, arguing that the chiropractor might not be able to perform the duties of treating patients, but they are able to manage a practice that offers other services. This is often called a “dual occupation” position that the insurance company may attempt to consider.Ready To Talk?
Insurance companies are known for their armies of economists, actuaries, and statisticians. Policies are backed by data to ensure profitability. They are also supported by an army of attorneys who understand that the fewer benefits paid by the insurance company, the more profits. And what most people do not know is that there is often no penalty to the disability insurance company for not paying claims.
Further complicating the chiropractor’s claim is the outlook that the insurance company will not consider the services of a chiropractor as a treating physician in a disability claim and will be highly skeptical about care provided by chiropractors, massage therapists, etc.
Here’s what a client had to say:
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.
Our first recommendation is to speak with an experienced disability insurance law firm that has represented chiropractors and understands the particular challenges faced by DCs. Our partners offer a free consultation and will review your situation. We will give you honest feedback about the challenges you may be facing, and will address the claim strategy.
Other steps to take:
If you have any questions, please call our office toll-free at 877-583-2524.
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