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July, 2012

Questions to Ask Before and After You File a Disability Claim

By Arthur Fries, RHU

Acting as your own advisor can be economically devastating in today's disability claim environment. It is prudent to seek the advice of an attorney on a legal issue or the advice of an accountant on a tax issue, but it is also prudent to seek competent advice when faced with the prospect of a disability claim. An experienced disability claim consultant with a successful history of selling disability insurance and providing advice on disability claims can help answer difficult questions and help you prepare to communicate effectively with insurance companies.

These are some questions that you may not be prepared to answer, yet each addresses an important facet of a disability claim.

Are You a Danger to Yourself and to Those You Give Advice to by Continuing to Work?

I continue to see chiropractors who continue to work in spite of medical symptoms that indicate they should stop. Cervical, hand problems and low back issues are just some of the medical symptoms I encounter that relate to this problem.  Chronic pain can cause one to have a lack of focus or not have the physical strength to perform a chiropractic adjustment properly.

Sometimes, reducing your hours can help and a PARTIAL disability claim would be appropriate. In other situations, a complete divorce from chiropractic adjustments may be the order of the day. 

If you have a "pure," your occupation definition for total disability in your disability contract, you can usually continue to own the practice and work in a management/marketing person scenario. In this case, you would still be considered totally disabled even though the practice continues to earn money for you. Another chiropractor could be hired to fill in for you or an associate chiropractor working part-time could have their hours increased to working full-time.

If the definition of total disability covers you in "Your Occupation" but also states that you cannot work in any other occupation, working now in a management/marketing capacity will define disability as a partial disability and will consider your earnings. If, after overhead expenses you do not have a 20% loss of earnings (for the practice) you will collect nothing.

Some insurance companies, even with a 20% or more loss of earnings, will still pay you nothing. So, it is important to clearly understand the definitions in your disability contract(s) so you know which direction to lean.

Do I sell my practice or continue the practice? You may have a choice, but moving in the wrong direction may cost you some big bucks! Denial, loss of identity, purpose in life and other factors all have a bearing on admitting you have a problem. By not admitting the problem, you risk being sued for malpractice, injuring a patient or both. If you "hold back" and don't do a procedure or don't do it properly, you risk losing the patient and if you lose enough patients, your practice will no longer even be saleable.

What is the Best Way to Transition From a Partial Claim to a Total Disability Claim?

You have reduced your hours or eliminated one of your chiropractic adjustments (Ex: A Side Posture) and you are collecting on a partial (residual) disability claim because of reduced earnings.

Over time, your medical symptoms have worsened whereby another chiropractor must be brought in to replace you. Since they may not be you in terms of experience, dedication and being a "major league player," their "minor league tendencies" might cause patients to leave the practice for a competitor. Or, you might have to pay another chiropractor so much money that it is not economically feasible for you to earn a profit.

In this case, you would want to sell the practice as quickly as possible and I recommend that you use a practice broker experienced in working with professionals (or even one limited to working with chiropractors) or certainly a business attorney who can help draft the proper contracts.

Do not call or notify the insurance company that you are planning to go on disability until the practice has been sold and/or you stop your clinical duties.

Doing so can only jeopardize your rights and the insurance company will not give you an answer until you actually stop clinical duties. It is crucial that you advise your treating physicians/chiropractors that your condition has worsened before you stop clinical duties.

In addition, all my clients provide a history letter of the reason for the transition from partial to total disability and samples of such letters are provided as a guideline. Do not make this serious error! Your disability policy has "Your Occupation definition" AND an "earnings definition" for TOTAL disability OR includes a "Not working in another occupation" in addition to the "Your Occupation" definition.

Consider this scenario if you have a "not working in another occupation" policy: You stop working clinically and manage the practice for a year. THEN you sell the practice.

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