A dentist practicing in the Southwest developed rheumatoid arthritis, a chronic, systemic autoimmune disease that causes pain, swelling, stiffness and potential deformity in the joints. The disease typically impacts the small joints of the hands and feet first, and then progresses to other parts of the body.
The dentist’s work required the constant, bilateral and precise use of his hands to manipulate forceps, retractors, drills and picks. It also required significant amounts of standing, bending, stooping and twisting. Because of his condition, the dentist began to experience significant pain and stiffness from performing the routine tasks associated with his profession. He had two long-term care disability insurance policies and filed claims with the insurers.
The Challenge
At the time his symptoms began, the dentist’s rheumatoid arthritis was in its early stages. Initial blood testing did not show the elevated C-reactive protein (CRP) levels typically associated with rheumatoid arthritis, so his diagnosis was one of exclusion. He also lacked the hallmark swelling associated with the disease at the outset, although this symptom appeared as the disease progressed.
Both disability carriers aggressively challenged the dentist’s claims due to the absence of definitive diagnostic markers. Another hurdle for the dentist was that his treating physician was unwilling to meaningfully participate in the claims process. (We ultimately determined that the physician’s lack of involvement stemmed from a reluctance to engage with insurers, which is, unfortunately, not uncommon.)
The Solution
Schwartz, Conroy & Hack, PC began representing the dentist in 2022. Partner Michail Hack leveraged our professional network to identify and assemble a team of rheumatologists willing both to treat the dentist’s condition and advocate on his behalf. In addition, Michail arranged for a Functional Capacity Evaluation (FCE) to assess the client’s ability to meet the physical demands of his occupation, including prolonged standing, bending, twisting and bilateral fine-motor manipulation.
One of the carriers ordered an independent medical examination (IME). After reviewing the insurer’s chosen examiner and uncovering significant bias, Michail formally objected. The carrier agreed to a new examiner, who conducted an independent review and concluded that the client was unable to physically perform the duties of a dentist. Prior to receiving that report, Michail issued document preservation letters to the IME physician, thus ensuring that initially supportive reports could not be subsequently altered to reflect an opinion financially favorable to the insurance companies.
Ultimately, we addressed and resolved all outstanding concerns raised by both carriers.
The Result
Because of our unwavering advocacy, determination and compelling medical evidence, one of the insurance companies agreed to buy out the dentist’s claim for nearly $1 million. The second carrier’s claim remains ongoing.
If your disability insurance claim has been denied or is being challenged, contact Schwartz, Conroy & Hack, PC. We have the expertise and tenacity to make insurance companies keep the promises they made to policyholders like you.
