Dentist disability claims are among the most difficult to win. This is because your insurance policy is more complicated (so there is greater opportunity to deny based on technicalities). There is also more money at stake for the insurance company. You should expect they will have their best people seeking to deny or limit your payments. Therefore, it is critical that you understand the unique challenge of dentist disability claims. So you can avoid mistakes and give yourself the best chance of success.
Most dentists who reach out to me are struggling with the same questions. Should I stop work and apply for long-term disability? Or should I just keep trying to work through the pain and mental stress? Should I get the surgery the insurance company is pushing, even if I disagree with it? If I take a break from work, how will I keep my practice afloat? Do I try to hire an associate? Do I need to sell the practice? Should I appeal the insurance claim denial on my own? Or should I get a lawyer?
I wrote this guide to help answer the above questions and more. Scan the table of contents below to look for the issue you are facing. You can download a free copy of my book A Beginner’s Guide to Disability Insurance Claims in Canada. Call us toll-free at 888-732-0470 or fill out the form below to request a free consultation. Our legal team will review your situation, explain your insurance policy, and help you come up with a plan for success.
Table of contents
- Why are dentist disability claims more difficult?
- When should a dentist apply for long-term disability benefits?
- When can a dentist refuse treatment recommended by the insurance company?
- How to file a dentist disability claim
- How our long-term disability lawyers can help with a dentist disability claim
- Request a free policy review & consultation
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Why are dentist disability claims more difficult?
Dentist disability claims are more difficult than typical long-term disability claims. Most dentists have individual insurance policies, which are more complicated to navigate than a group long-term disability policy. As a business owner, taking a sick leave is more complicated than if you were an employee. As high-income earners, dental disability claims involve larger sums of money. This means the insurance company has much more to lose. You will be dealing with their very best people. It is financially worthwhile for them to spend more money to investigate and defend against your claim.
When should a dentist apply for long-term disability benefits?
The answer is easy in theory, but hard in practice.
You should apply for long-term disability benefits when the insurance company will approve your claim. The problem is that most dentists aren’t sure when they reach this point. I have yet to meet a dentist who didn’t struggle with the idea of leaving work to go on long-term disability benefits. I expect you are no different.
This is understandable. You are a type A high achiever. There isn’t a problem you can’t fix with hard work. You have spent years in school and worked hard to build your practice. Like many others, you have a mortgage and other financial responsibilities. It’s unthinkable to just stop work and put your faith in an insurance company.
If you suffer a catastrophic injury or illness, then the decision is taken out of your hands. However, most dentists who reach out to me are struggling with chronic illness. They have carpal tunnel syndrome, depression, neck pain, back pain, or other chronic illnesses. Most have been struggling for a while and are reaching a breaking point.
I can tell you from my experience 100% of people will eventually reach the breaking point. You can only work under stress and in pain for so long. You will eventually crash. If you push too hard, then that crash can be bad.
I urge you to reach out to us, or another disability lawyer you trust, to review your situation and discuss your options. A disability lawyer can help you plan a successful transition to sick leave. We can let you know if you would qualify for long-term disability right now, or if you should keep working for a bit longer. We can let you know what medical evidence you will need to prove your claim.
Factors to consider before applying for disability benefits
No two situations are exactly alike. Don’t rely on anecdotal advice from others because their situation will have been different from yours. Even your doctor can get this wrong. Getting approved for disability benefits involves meeting legal requirements as much as medical requirements. So, your strategy will need to be unique based on a number of factors, including:
- your age
- medical condition
- current treatment
- recommended treatment
- financial and billing history
- practice type
- claims history
- family dynamics
When can a dentist refuse treatment recommended by the insurance company?
Disputes over treatment are one of the most common reasons for insurance companies to stop payment on a dentist’s disability claim. Your claim gets approved, but there comes a point when you have exhausted conservative treatment. Your insurance company will hire a doctor who says you should undergo more invasive treatment or surgery. You and your doctors may question this.
For many chronic conditions, surgery is not an absolute cure and can often make things worse. Now the issue is: should you get the surgery or other invasive treatment. And if not, does the insurance company have the right to cut off your payments?
This area of disability claims is covered by the law of mitigation. As a disability claimant, you have an obligation to take reasonable actions to minimize (or mitigate) your losses under the contract. But when is it reasonable to refuse treatment? The Supreme Court of Canada addressed this legal requirement in a famous case called Janiak v. Ippolito. This case created the rules for when a person can reasonably refuse treatment in the context of a disability claim.
If you find yourself in a dispute over the “right” treatment, you should seek legal advice immediately. The law in this area is not always easy to understand or apply in individual cases. You need to tread very carefully. It is critical that you don’t create the wrong narrative or have well-meaning doctors say the wrong things. You have a lot at stake, so you need to have the right strategy for your situation.
How to file a dentist disability claim
Dentist disability claims are more complicated than a typical long-term disability claim. With most policies, you have to submit billing and financial records for past years. You will need to prove your disability has resulted in a loss of income. There are also different types of disability, including total disability, partial disability, and presumptive disability.
You make the disability claim by filling out forms and sending them to the insurance company.
How our long-term disability lawyers can help with a dentist disability claim
Our long-term disabilty lawyers can help you in the following ways:
- Give you a free strategy session, which includes a review of your policy, claim forms, and medical records
- Explain all the terms of your policy and the things you need to watch out for
- Help you know when it’s the right time to apply for long-term disability
- Help you avoid professional and regulatory issues when taking a sick leave
- Explain what medical information is needed to maximize your chances of success
- Identify the red flags for your situation (from the insurance company’s perspective)
- Explain if your refusal of recommended medical treatment is allowed under your insurance policy
- Represent you in applying for long-term disability
- Represent you in appealing a denial
Request a free policy review & consultation
Fill out the form below to request a free policy review. Once you submit the form, our team will email you to get a copy of your policy. Our lawyers will then review your policy and explain it to you. We can also review other documents like letters from the insurance company, insurance forms, medical reports, etc.