By Ray Bourhis, Esq. & Alexander MacDougall, Esq.
As the nation’s most common cause of disability, arthritis is also one that has devastating repercussions for anyone whose livelihood depends upon their dexterity. Because arthritis causes swelling of the joints resulting in pain and joint stiffness and loss of flexibility and muscle weakness it is a particularly problematic condition for medical specialists from ER doctors to surgeons. Treatments for arthritis can vary, however the disease is basically incurable and for most medical professionals it has a devastating impact on speed, strength, flexibility, and precision.
Medications can offer some degree of relief from the symptoms of arthritis and include analgesics (such as acetaminophen, oxycodone, and hydrocodone), NSAIDs, counterirritants, and corticosteroids. Unfortunately, while the medications can provide some relief from the pain, the side effects dull the patient’s senses and cloud their thinking leaving them in a state which compounds the situation.
Take for example, a microsurgeon with rheumatoid arthritis. Microsurgeons typically perform such procedures as replantations, tissue transplantations, nerve repairs and grafts, extremity reconstructions, and facial paralysis re-animations. To perform such procedures, the microsurgeon must use very delicate and precise movements that are impossible to perform normally with the type of joint pain and stiffness caused by rheumatoid arthritis.
When dealing with the insurance carrier, it is critical that the claimant’s representative have a thorough and in-depth understanding of the claimant’s substantial and material duties pre-disability. He or she has to know precisely how the doctor’s disability has impacted their ability to perform those duties. Most carriers will attempt to under pay (low ball) benefits by attempting to pay under a Partial or Residual provision in the policy rather than under Total Disability. Having a detailed and precise knowledge of the claimant’s pre and post disability activities is the only way to avoid this.
It is essential to realize that the information given to an insurance company at the beginning of the claim will resurface during the course of the investigation of the claim; in a question raised during an IME, or in a discussion with the claims department during a telephone interview. The importance of being thorough and accurate in all such communications cannot be overemphasized. Even a minor inaccuracy can be interpreted by the insurer as an attempt to exaggerate or mislead. This can have devastating consequences, with an arthritis claim or any other.
For our firm, having a reputation with the carriers for a high level of competence and integrity has proven invaluable to us and worth a great deal to our clients.