Your Insurance: Dentist Works with His Disability—and His Insurance
When David Chen, DDS, fell off a ladder at his home one snowy morning 6 years ago, he was left with three spinal compression fractures and the prospect of never practicing dentistry again. “Initially, there was talk of surgery, but I was reluctant to do that,” Dr. Chen recalls. “I decided to use a combination of physical therapy, swimming, and other exercise to try to get better.”
SOBERING STATISTICS
Dr. Chen’s accident demonstrates two sobering statistics according to the National Center for Health Statistics:1 Forty-four percent of all self-reported, nonfatal injuries occur in or around the house, and falls are the leading cause of unintentional injuries. However, Dr. Chen was determined to avoid becoming a third statistic: a dentist who is totally and permanently disabled from the practice of dentistry.
As Dr. Chen worked at his rehabilitation, he managed to keep his practice open on a limited basis. “I can walk, but I can’t stand up for very long because I have permanent nerve damage and numbness in both feet,” he says. “I’ve accepted the fact that I’ll never be able to practice full time again, but at least I can practice part time as my health permits.”
To supplement his reduced earnings while working part time, Dr. Chen has been able to tap into the disability income coverage he has through the American Dental Association (ADA) group policy. When he purchased the insurance, he elected an option that provides a “residual” (or partial) disability benefit without requiring any period of total disability. This option has proved to be especially valuable for Dr. Chen because he was never totally disabled by the fall yet experienced a significant loss of income. Without that option, he might not have qualified for disability benefits at all.
HOW IT WORKS
A residual disability benefit helps a dentist recover a portion of earnings lost as a result of a partial disability. Here’s how a residual benefit works, using Dr. Chen’s ADA In-come Protection Plan as an example.
At the end of each month, the disabled dentist submits income information to Great-West Life & Annuity Insurance Com-pany (Greenwood Village, CO), which underwrites and administers the ADA Income Protection Plan. The income from treatments and services personally provided by the dentist is compared to his or her earnings before the disability, and a percentage loss is calculated. Income generated by other producers in the practice (like associates or hygienists) is not considered, and therefore does not diminish the benefit amount that the disabled dentist is eligible to receive.
This percentage loss is used to determine the residual benefit for that month, which is the proportionate amount of the dentist’s maximum monthly benefit for a total disability. To illustrate, assume that the dentist has an allowable benefit of $10,000 a month. In May, the dentist’s loss of income is 50%. He would receive $5,000 in residual disability benefits for the month. However, if the dentist’s earnings fell below 20% of his or her pre-disability earnings, the full $10,000 would be paid.
In addition to monthly earnings records, the dentist periodically provides medical information to Great-West Life to substantiate the partial disability claim. This information includes current records from the dentist’s attending physician. In addition, the dentist must be receiving appropriate treatment for the disabling condition. “We might need to review the dentist’s medical records as often as every 6 months, or as infrequently as every 1 or 2 years, depending on the nature of the disability and the treatment being provided,” explains Elaine Saxen, a senior disability consultant at Great-West Life. “Because we insure only dentists under the ADA Income Protection Plan, we know their physical limitations regarding the performance of general dentistry or any specialty, and we can check on the status of an ongoing disability without being overly invasive.”
CONCLUSION
Now 62, Dr. Chen says that seeing patients helps take his mind off his injury. He also has another motivation to keep working: his dad. “My father, who is a kidney specialist, told me that if I just sat on the couch and watched TV, my condition would get worse,” Dr. Chen recalls. “After all, he’s 92 and still practicing.”
REFERENCE
1. 10 Leading Causes of Nonfatal Unintentional Injury, United States, 2006. Available at: www.cdc.gov/ncipc/wisqars/nonfatal/quickpicks/quickpicks_2006/unitall.htm. Accessed January 24, 2008.
Editor’s note: Dr. Chen’s statements were obtained by Great-West Life & Annuity Insurance Company, underwriter and administrator of the ADA Insurance Plans, relative to his coverage under Group Policy #1105GDH-IPP, and reprinted with permission. For more information, visit www.insurance.ada.org or call 888-463-4545. This article does not constitute legal, tax, or financial advice; please seek professional input as appropriate to your situation.
