Protective Life’s Special Role in Dentist Disability Insurance
Protective Life is well known in the dental profession, as it has a decades-long history of selling disability insurance policies to members of the American Dental Association (ADA). The company is the current insurer of the ADA Disability Income Protection Insurance Plan. This disability insurance coverage is exclusive for ADA members and includes an “own occupation” definition of disability that can pay benefits to age 67.
The ADA-Protective partnership produces a disability plan specifically tailored to the risk profile for dentists. Dentistry is a hands-on profession that requires precise fine motor skills, physical stamina, and the ability to maintain ergonomically demanding working positions for extended periods. Dentists are uniquely vulnerable to disabilities affecting their hands, wrists, arms, neck and back conditions that might be considered minor inconveniences in a sedentary profession but can completely eliminate a dentist’s ability to practice their specialty.
With 1 in 4 dentists likely to experience a disabling condition, this plan provides full benefits if total disability prevents an ADA member from practicing in their specialized dental field with benefits continuing to age 67 even if the dentist practices in other dental areas or switches professions entirely.
This makes Protective Life denials especially high-stakes: the insurer is holding back benefits from a policy specifically designed for dentists one that can represent millions of dollars over a career.
Protective Life’s Tactics for Denying Long-Term Disability Claims for Dentists
Protective Life is the insurer behind the ADA Disability Income Protection Insurance Plan the most widely used disability policy among dentists in America. Protective has developed a systematic playbook for denying sometimes and limiting claims. Once a claim goes into payment status, Protective Life can be reasonable for the life of the claim. The key is getting the claim paid at the outset. Here’s a breakdown of every major reason why they do it, and how.
The Financial Motive Behind Every Denial
Unfortunately, Protective has a powerful profit motive to deny claims. Dentists’ LTD claims are particularly tempting for insurance companies to deny for two main reasons: first, the hyper-technical nature of dentistry makes their productive functionality especially vulnerable to injuries that insurers consider “minor”; and second, the high dollar value of dentists’ benefits makes it more financially worthwhile for the insurer to deny and fight related appeals than to approve the claim.
Dismissing “Minor” Injuries That Are Catastrophic for Dentists
There are few professions where a minor finger injury can be the difference between expertly performing complex, highly technical procedures and being completely incapable of performing even the most basic job duties. Dentists require fine motor skills and proprioception to the tenth of a millimeter to perform their occupation effectively and safely. Any impact on their precision creates an environment where they should not be practicing, as they risk harming patients. Because of this vulnerability, insurers often discount the disabling impact of what they view as “minor” injuries which they do not believe should realistically prevent a dentist from performing their job duties.
The Strict “Regular Care of a Physician” Trap
What differentiates Protective’s policies is how they define “regular care of a physician.” Unlike most other disability policies, Protective requires care and treatment at intervals and frequency that will tend to lead to a cure, alleviation, or minimization of the condition causing the total disability. For example, if the claimant suffers from carpal tunnel syndrome and surgery is a possibility, Protective could claim that refusal to undergo surgery means the claimant fails to satisfy the Regular Care and Treatment provision and deny the claim on that basis.
Paper Medical Reviews Without Examining the Claimant
Occasionally, Protective’s consulting physicians reviewed paper records without ever physically examining the patient. Rather than scheduling a true independent medical exam, the insurer conducts a paper review in which there is no personal, hands-on medical examination of the claimant by a qualified physician. This tactic is particularly common in claims for subjective impairments such as chronic pain, depression, or nerve conditions that cannot be easily proven through standard objective testing like X-rays or MRI. Proactively gathering strong medical evidence is important for winning a claim and once on claim, staying on claim.
Beware of Biased Independent Medical Examinations (IMEs)
It is common for insurance companies to administer independent medical exams (IMEs), which are rarely unbiased, as the doctors who perform them routinely work for the insurance company or vendors who serve insurance companies
There are groups of doctors who are regularly sought and used by insurance companies for medical reviews and IMEs, and the lion’s share of these doctors’ business is based on IME work. The IME doctor is rarely a specialist in the claimant’s medical condition. A general medical doctor or nurse may be examining conditions ranging from a complex spinal cord disorder to chronic pain.
Insufficient or Poorly Documented Medical Evidence
One of the most common reasons for denial is the lack of adequate medical evidence confirming a disability. Because dentists typically have deep medical knowledge, some may forgo visits with physicians, leading to a lack of documentation of their conditions, symptoms, and treatments. Dentists must provide comprehensive documentation, including both objective and subjective medical evidence, to support their claims.
A medical diagnosis alone is not enough: dentists must show how symptoms prevent the dentist from performing high-risk tasks safely, including reduced grip strength, tremors, impaired vision, pain with leaning or rotating, or cognitive fatigue. Insurers often argue that they can continue practicing even when doing so might be unsafe.
Using Claim Forms Against the Dentist
The initial proof of loss packet is the most important set of claim forms because it sets the tone for the entire claim. Claim analysts are trained to review these forms to determine occupational duties, the extent of restrictions and limitations, and the severity of the condition. Many dentists do not realize that the claim investigation is administered by Protective Life and not the ADA, relying on Protective Life to guide them through the process is a dangerous mistake.
Several dentists have become involved in claims where they reviewed the paperwork, did not understand why certain information was being asked, skipped those questions, and returned partially completed forms, which leads to frustrating delays, as insurers typically refuse to move disability claims forward until all forms are complete. It is important to provide overwhelming proof of disability from the get-go. This is the best way to get paid promptly.
Surveillance and Social Media Monitoring
Insurance companies often hire private investigators to follow and photograph claimants. Social media platforms are monitored as well. Too many claimants have run into problems by posting to social media. The best advice is to avoid social media.
Post-Surgery Denials
While the disability insurance company may accept a short-term disability claim following surgery, it will likely deny a long-term claim after surgery when the surgeon does not support continued impairment. If post-surgical symptoms are pain and numbness in the extremities which the insurance company considers subjective, the dentist could face another challenge for disability benefits after attempting to return to work.
Misclassifying Occupational Duties
Allowing the insurer to rely on a generic job description that fails to reflect the true requirements of dental practice is one of the most common reasons dentists see their claims denied. Insurers often argue that a dentist can continue practicing even when doing so would be unsafe for patients.
Insurers could say that even with a physical limitation, a dentist could carry out administrative duties and use this to claim the dentist is not “totally disabled,” even if they cannot see patients or perform procedures. There is well-known litigation involving a dentist in Michigan who practiced less than full-time dentistry but manage three dental offices. Despite fighting another insurer for years, this case worked out well for the dentist after years of litigation. Leonor v. Provident Life & Acc. Co., 790 F.3d 682 (6th Cir. 2015)
What To Do After a Protective Life Denial
- Gather specialty-specific functional evidence occupational therapists, hand specialists, neurologists
- Document your specific job duties meticulously (fine motor tasks, sterilization protocols, patient load)
- Gather proof of your loss of functionality.
- Perhaps hire an attorney who specializes in disability insurance claims and litigation.
How Jonathan Feigenbaum Helps Dentists Fight a Protective Life LTD Claim Denial
Attorney Jonathan M. Feigenbaum has spent more than 30 years helping clients get the disability benefits they need and are entitled to and has directly represented individuals in claims against Protective Life and virtually every other major long-term disability insurer. Here’s specifically how he helps a dentist who’s been denied:
He Knows Protective Life’s Playbook
Feigenbaum understands what motivates Protective Life. Feigenbaum knows tactics of this insurance company and how to counter them.
Thorough Case Evaluation and Appeal Preparation
If your claim has been denied, Feigenbaum will request the entire claim file from your insurance company and spend time evaluating its contents. His structured approach includes a detailed review of denial letters, medical records, insurance policy provisions, and employment history to identify errors and inconsistencies by the insurer.
For dentists specifically, this means carefully examining whether Provident correctly applied the own-occupation definition, a critical distinction for dental professionals whose disability may prevent them from practicing dentistry even if they could do other work.
Handling the Appeals Process Correctly
After a claim is denied but before filing a lawsuit, you are required to appeal in writing to the insurance company and a one-line note saying you’re appealing is not sufficient. Feigenbaum’s experience in appealing denied disability claims will guide you through the protocol and increase the possibility that your appeal will be granted.
This is especially important because the administrative record built during the appeal often locks in the evidence that can be used in any future litigation.
Litigation When Necessary
If your appeal is not granted, or if the insurance company does not offer a fair settlement, Feigenbaum can help you secure benefits through litigation in state and federal courts. If you purchased a long-term disability insurance policy individually, state law governs your claim and you have more options than those filing under ERISA.
When insurers refuse a fair settlement, Feigenbaum stands prepared to escalate claims to litigation in state or federal courts, zealously advocating for clients’ rights to full benefits under the law.
Bottom Line
For a dentist, LTD insurance isn’t just a financial product; it’s career survival insurance. A Protective Life denial isn’t the end of the road; these claims are frequently overturned on appeal or in litigation, especially with proper legal and medical support. The benefits at stake potentially millions of dollars over a career make fighting back almost always worthwhile.
Call today at 617-357-9700 or visit erisaattorneys.com to schedule a complimentary consultation.