Every day, chiropractors help their younger and older patients manage upper and lower extremity injuries and sickness, among other conditions. For those who have greatly benefitted from our chiropractors’ adjustments, there aren’t enough good things to say about how great you feel.
Unfortunately, most don’t appreciate the amount of strength, care, and expertise that goes into aligning patients by properly positioning them, making sure patients are in the perfect line of drive so the chiropractor can administer the manipulation. Big and small, young and old, chiropractors treat everyone and often use their entire body to deliver the proper amount of force to complete the adjustments. Chiropractors typically maneuver, position, and provide multiple adjustments, usually eight to 10 different manipulations before each patient’s treatment is finished.
Some days, a chiropractor may treat over 50 patients, delivering hundreds of adjustments with the proper amount of force, strength, and energy, which is very similar to unloading a full 45-foot tractor trailer. Chiropractic work is a high-impact occupation and extremely cognitively demanding.
Ironically, and sometimes tragically, chiropractors deal with the same sicknesses and injuries as their beloved patients because of years of lifting, repositioning, and manipulating them. Unfortunately, sudden injury or sickness can lead to long-term or career-ending disabilities. These injuries and illnesses also can lead to insurance claims, and, more specifically, tricky, often-complicated disability insurance claims.
Chiropractors and the Attending Physician Form
When a patient visits a chiropractor because he or she is in the middle of a group short or long-term disability insurance claim, the chiropractor is often asked to be the attending physician and fill out an attending physician statement for the claim to be properly made. As a result, chiropractors need to be well versed in multiple disability insurance issues for their clients as well as for themselves. Disability insurance carriers ask questions about patients’ occupational, physical, and mental demands; necessary cognitive abilities; and the amount of sitting, standing, walking, bending, stooping, and lifting required for the job.
However, dealing with billion-dollar disability insurance companies can often be difficult. Whether chiropractors are helping a patient get a necessary assessment or filing their own disability claim, it’s important to know the claim steps in the disability process. Here are some helpful ideas when short or long-term disability insurance issues arise.
"Insurance companies love to videotape their allegedly disabled insureds doing activities arguably inconsistent with their disability."
How Chiropractors Help Patients Receive Disability Approval
It is critical to take a detailed medical history and understand whether the patient is dealing with an accidental injury or sickness. When was the injury? Where did it occur? How did it happen? What care or treatment has occurred to date? What testing has been performed (X-ray MRI, CT scan, EMG, NCV)? What medications does the patient take? Are there side effects? Has the patient experienced cognitive dysfunction or sleep disruption? Were pain levels documented on a scale of 1 to 10 with office testing to objectify the patient’s self-reported symptoms? Finally, a doctor needs a thorough explanation of the patient's occupational limitations and restrictions.
A treatment plan with a projected return-to-work reference may also be expected when a chiropractor fills out an attending physician statement for the patient. Asking for a job or occupational description eliminates any guesswork about the demands of the patient's work as you frame whether injuries or sicknesses prevent the patient from returning to the position, or in some cases, whether the patient is able to do the important duties of “any occupation” for which he or she is trained or suited.
What Type of Disability Coverage?
Chiropractors should also be aware of what type of disability coverage the patient is seeking. Short-term disability (STD) usually lasts from seven days to 26 weeks and often provides occupation-specific coverage, so if patients can’t do the substantial and material duties of their own occupation, then they are disabled. Long-term disability (LTD) usually follows short-term disability and can have a waiting period of 30, 60, 90, 120, 180, or 365 days before benefits start. LTD policies usually cover the employee for 24 months in their own occupation, and then the disability definition usually switches to any occupation for which the insured is trained, educated, or suited. Individual disability policies purchased from an agent or insurance broker typically pay tax-free benefits, and the coverage can be “occupation-specific” for 24 months, 60 months, to age 65, to age 67, or for the lifetime depending on the sickness or injury and policy’s provisions. STD, LTD, and individual policies usually also provide residual benefits if the insured has a 20% loss of earnings and can only do some of their occupational duties less than full time.
Musculoskeletal Limitations?
Unfortunately, patients and their chiropractors are often surprised to learn their disability policies may contain musculoskeletal limitations that cap disability benefits at 24 months or less, unless the patient has documented radiculopathy by testing. So, be mindful that if your patient hasn’t read the fine print of his or her disability coverage, it could be limited without objective testing. Be very careful to avoid tricky language or policy limitations.
Mental Nervous Provisions
Most group long-term disability and individually purchased policies have mental/nervous limitations that can also limit a physical claim that a chiropractor is treating. Suppose the patient has had back surgery, which did not entirely cure the pain, or the patient had continued restricted movement, and the patient comes to the chiropractor for help. As part of the patient’s history, sadness and depression are often charted because of the failed surgery. Some policies have mental nervous limitations that if your sadness or depression contributes to your physical disability, the benefits can terminate in as short as 12 months, so be very careful.
Occupation at the Onset
Determining what occupation the insurance company attaches to your patient is always based on the occupation at the onset of the claim. It is not the day, week, or month before the disabling injury or sickness struck down your patient; it’s the year or two before the claim, where time spent on specific occupational duties or money earned from substantial work is measured. It is very important to understand your patient’s occupational duties and if the physical demand is sedentary, light, medium, or heavy.
Sickness or Accident
It is critical to determine whether you are treating a sickness or an accident; the type of disability coverage may be an issue; the definition of disability; and how long benefits will be paid, along with any specific benefit limitations or caps.
Doc-to-Doc Calls
Chiropractors are also often asked to speak with a disability insurance company’s on-site doctors or third-party medical reviewers. Please make sure you or your staff members are not caught off guard without the chart because carriers can be aggressive. Set a convenient time for you, ask to be compensated, and ask that the on-site insurance company doctor or third-party reviewer put their questions in writing so there won’t be any dispute about who said what to whom. Remember to document the conversation in your chart notes following any “doc-to-doc” call and make sure the patient understands the carriers’ medical position.
Videotape Surveillance and the Paparazzi
Insurance companies love to video their allegedly disabled insureds doing activities arguably inconsistent with their disability. If you say your patient can’t bend, lift, push, pull, or carry, and your patient is filmed loading cases of water into their vehicle at Costco, then their claim may be in jeopardy. Always ask the insurance company for the unedited video and any written report by their investigator so you can watch and arrive at your own conclusions. Sporadic efforts or occasional bursts of energy may look damning on tape, but courts want the disabled to try to get better by doing things. Most carriers like to video around the holidays for three days in a row to eliminate the “had a good day” argument. Medication can often aid the insured while they do the necessary lifting, bending, driving, and sitting. Remember that none of these group or individual disability policies comes with a chauffeur or individual shopper.
Referring the Patient to Other Medical Specialties
Often, despite repeated manipulation or your office-based physical therapy and home exercises, the insured needs further medical treatment, testing, medication, and support. X-rays, MRI, CT scan, EMG, NCV, pain management injections, and sometimes even surgery, are necessary. It is crucial to create a thorough, comprehensive chart that outlines your care, treatment, diagnosis, prognosis, and ultimate referral.
How to Objectify Self-Reported Problems Like Pain and Fatigue
Insurance companies like objectivity and testing that clinically captures pain and fatigue complaints. Marrying subjective complaints of radiating pain with straight leg testing and MRIs is one example. For patients with CFS or fibromyalgia, meeting the CDC's requirements for each disease is a good start, but sending your patient for a functional capacity evaluation for two days can really objectify work demands of sitting, standing, walking, and lifting with documentation of increasing pain and fatigue over a two-day exam.
Be Careful and Stay Tuned For More
Chiropractors are highly susceptible to the conditions they treat on a daily basis, making an understanding of the disability insurance process important for both assisting patients and potentially filing their own claims. Disability insurance claims can be difficult to navigate, full of twists and turns that can often result in wrongful delays or denials. Reviewing your own disability policy’s features, advantages, and benefits is crucial before you contemplate filing your claim for benefits. There are also huge differences between group-sponsored FTD policies and individual coverage purchased from an agent or broker. Dual occupations at the onset of disability, where the carrier says you are a business owner and still capable of part-time work as an owner, versus being truly disabled from the heavy manipulation demands of a hands-on chiropractor, are common carrier tactics to deny.
Frank N. Darras is the founding partner of DarrasLaw, the largest disability insurance litigation firm in the country. Recognized as America's top disability attorney, Mr. Darras has been prominently featured in the Wall Street Journal, Forbes, USA Today, Money Magazine, Medical Economics, Smart Money, Chiropractic Economics, CNBC, the Los An®geles Times, the New York Times, and The Wall Street Journal. He has dedicated his life to helping the sick and disabled. Mr. Darras has helped well over 1,000 chiropractors make and timely receive their disability benefits.
