Page 17 - Bulletin Vol 31 No 1 - Jan. - April 2026 FINAL_

Legal Article | Long Term Disability

What to Know Before You Disable Your LTD Claim
Most dentists assume that if they become injured or ill and can’t work, their long-term disability insurance
will pay monthly benefits. After all, that’s why they bought the policy. What many dentists don’t realize is
that getting a disability claim paid requires more than a diagnosis.
Long-term disability claims are contractual claims, governed by detailed policy language and managed by
insurers whose financial interests don’t align with the claimant’s. For dentists, whose work depends on
precision, endurance, and consistency, small missteps early in the claims process can have outsized conse-
quences later.
LTD claims are not handled like routine insurance matters and are not evaluated with the generosity many
professionals expect. Well-intended actions taken early and without legal guidance can be misinterpreted,
used out of context, or cited later as reasons to limit or deny benefits.

Different Types of Disability Policies With Different Guardrails
Dentists’ disability policies generally fall into three different categories:
• Association policy – typically purchased through the ADA when the dentist starts out in practice.
• Group or ERISA policy – part of employee benefits for dentists working in larger practices, a hospital
system or in a corporate dental practice.
• Private or individual policy – purchased privately from an insurance agent.
The first two – association and group – are governed by federal law and present a number of unique chal-
lenges. If a claim is denied, a restrictive administrative process must be exhausted before a dispute can go
to federal court. If a dentist’s claim is denied, doing the appeal without the guidance of an experienced
LTD attorney puts the claim at risk.
Private disability insurance disputes can go to litigation from the start, but if an appeal can succeed, this is
a far better (and less costly) solution than litigation.

The Unique LTD Risk Profile of Dentists
Dentistry is physically and cognitively demanding in ways that are underestimated by insurers. Dentists
commonly experience musculoskeletal disorders, repetitive stress injuries, neck and back pain, hand and
wrist conditions, vision problems, neurological issues, and mental health challenges related to chronic
stress.
What makes these conditions particularly difficult in LTD claims is that many are progressive, variable, or
subjective. A dentist may be able to work part-time, perform limited procedures, or push through pain on
some days and not others. Insurers seize on these fluctuations to argue that a claimant is able to perform
their duties, even when the dentist knows otherwise.
Statements like “I’m managing,” “I’m trying to keep my practice going,” or “I can still do some procedures”
may feel honest and reasonable. In the LTD context, they can be disastrous.

Why Early Statements Matter
From the moment you notify an insurer of a potential claim, a claims file begins to take shape. Every form
completed, every phone call made, and every medical record submitted becomes part of a file that will be
subject to intense scrutiny throughout the life of the claim.
Insurers are not simply gathering information; they are building a case against your claim. That case will
focus on what you can do, rather than what you cannot do, and on isolated data points rather than the
cumulative demands of dentistry.
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Nassau County Dental Society ⬧ (516) 227-1112 | 17