Overwhelmed by Stress? File for Long-Term Disability

Matthew Bourhis, Esq.
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Stress is a silent epidemic in America, especially within the profession of dentistry. The National Institute of Health has categorized dentistry as one of the most stressful professions in the country. The consequences, of course, can be life changing.

According to the Mayo Clinic, stress causes depression, anxiety, irritability, muscle pain, lack of motivation, and feelings of being overwhelmed. Sadly, this phenomenon manifests in extremely high rates of suicide among dentists—8% for men and 5% for women, compared to 0.4% for the national average.

Like many high-level professionals, dentists face a conundrum when they are dealing with stress. The job is stressful, but it pays the bills. Although quitting would extinguish the stress of your occupation, it also would create new stress because you would lose a major stream of income. The obvious solution is often overlooked. File a disability insurance claim.

What Disability Insurance Covers

It should be no surprise that stress, a bona fide medical impairment, falls within the coverage of disability insurance. Likewise, comorbidities, including those stemming from stress medication, also fall within the purview of disability insurance. However, there is a common misconception that disability insurance really just covers conditions like cancer and car accidents. This is not true.

Part of the problem is that insurance companies convince their policyholders that conditions like stress, depression, anxiety, and burnout do not rise to the level of disability that is covered by their insurance policy. This is a common refrain from insurance companies, and it deters policyholders from filing payable claims.

Let’s take an example to see how it actually works. Dr. Doe, who owns a private dental practice, has had a very stressful year. Her practice was shut down due to COVID-19, her income stream dried up, her children are driving her up the wall with home schooling, and her social life is at rock bottom.

When you look at the whole picture, Dr. Doe has been drinking a witches’ brew of stress non-stop. She begins to experience depression, anxiety, and burnout, and it is affecting her ability to provide care to her patients. She needs a change, and her treating physician has noticed a decline in her work capabilities. So, she decides to sell her dentistry practice and start a new business designing shoes.

Dr. Doe calls her disability insurance company to inquire whether she is entitled to monthly benefits. The claim representative tells her, “Oh no, I wouldn’t even file a claim. Everyone is stressed these days. You made a personal choice to change your occupation, so you are not covered.”

Insurance companies do this constantly. The reason is because once the policyholder files her claim, it triggers a duty for the insurance company to investigate that claim. The law now requires the insurer to perform a thorough and fair investigation and pay the claim if the policyholder satisfies the conditions for coverage. If you never make an official claim, there is no such duty

This is an easy, defensive tactic that insurance companies use all the time to fend off insurance claims. It not only saves them the time and expense of performing an investigation, but also saves them a tremendous amount of money because they never end up paying the benefits. On top of that, there is minimal risk of being sued, because there is no formal claim denial, thus no breach of contract.

What You Need to Do

So what can you do? First, you must insist on filing a claim. Respectfully demand that your insurer send you the claim forms and instructions. Do this in writing, preferably via email so it’s time stamped. If the insurance representative discouraged you from filing, put that in writing too. Send an email to your insurer summarizing your conversation.

For example, “On this date, I spoke with this claim representative, who advised that I not file a claim.” You do not need to editorialize. Just explain what happened for the record. Ultimately, this can be useful evidence if your insurer eventually denies your claim and you need to sue.

So, you filed your claim. You went through the tedious process of filling out your claim forms, getting your doctor to write an attending physician statement, gathering your medical records for your insurance company. Now what?

Every disability insurance claim based on stress creates pushback from insurers, because they are skeptical of latent medical conditions. It is, therefore, crucial for you to bolster the credibility of your case.

For starters, you need support from your doctor, preferably a stress specialist. The law in California, and many other states, is that the treating physician’s opinion is of paramount importance. Having your doctor write a letter on your behalf can be tremendously valuable.

This type of letter should explain the doctor’s professional understanding of stress and his or her personal observations of your impairments. If the doctor supports a career change or time off work, make sure that is included in the letter.

What disability insurance claims boil down to is whether you have a real medical impairment that hinders your ability to perform the substantial and material duties of your occupation in the usual and customary manner.

Stress, especially these days, can be a dramatic impairment for dentists, but proving it is a different story. If you take the proper steps with your disability insurance, you will not only reap the financial benefits, but more importantly, you will be able to prioritize your well-being.

Mr. Bourhis is an attorney with the Bourhis Law Group. He represents claimaints in disability insurance, homeowners insurance, and business insurance disputes. He also frequently writes about insurance and has been published in the LA Times, among other news outlets. Prior to joining the Bourhis Law Group, he served the California Supreme Court and the Honorable Martin J. Jenkins. He earned his JD from King Hall, University of California, Davis School of Law. He can be reached at info@bourhislaw.com.

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