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Ginsberg: And welcome back to the Lisa Wexler show. This is Seth Ginsberg, America's patient advocate, filling in for Lisa Wexler who's on vacation, a much-deserved break where she's headed "Down Under." We're on "the Highway to Health" right now and we're talking all about how to improve access to care, how to change the story we tell ourselves and how we can become our own advocate. I am joined now by our next guest, Glenn Kantor. Glenn, you there?


Kantor: I'm here.


Ginsberg: Let tell everybody why they should be so excited to hear from you because you're a lawyer. Kantor and Kantor.  You're a partner at one of most experienced and respected law firms dealing with the prosecution of claims against insurance companies and you represent clients whose insurance companies have failed or refused to pay claims arising out of disability, health
, life, long-term care and other liability insurance claims. So actually, you are a very important lawyer. You're the good guy, is it safe to say?


Kantor: I would like to think so.


Ginsberg: I'd like to think so as well because inevitably those of us who face health issues or disability issues, have to do battle. We have to literally put on our armor. We have to shine our sword in terms of gearing up to deal with the fights we have to fight against the people or the companies responsible for paying our share and paying for their responsibility in terms of coverage or insurance and that's not always as it seems, is it, and that's never uh, doesn't always go as smoothly as it should, does it, Glenn?


Kantor: Absolutely not. My day is filled with helping people who have valid claims, typically for disability or life insurance benefits that have been denied by the insurance company.


Ginsberg: So really, an insurance company at the most basic level, the model is to mitigate risk or identify risk and then pay out as little as possible.


Kantor: That's certainly my experience, yes.


Ginsberg: Wow. Well, ya know, a good thing that we're all forced to have insurance. (laugh)

Ya know, I think I'd like to take a minute here to talk about long-term disability because I think it's an issue that doesn't get a lot of coverage or discussion and I think it's an important one because basically, I'd  like you to speak to why a lot of disability claims, long-term disability claims are denied in your experience.


Kantor: Ok. First, I just want to start by explaining that there is a difference between Social Security disability, which everybody has by paying in payroll taxes and employer-provided long-term disability, which is often provided through an insurance company.  When your coverage is employer-provided, insured or self-funded by your employer, it's governed by a federal law called ERISA. And that law, well, it stands for "the Employee Retirement Income Security Act", it's really become "the insurance company protection act" because while many state laws would allow what we call extra contractual damages when they improperly deny a claim, the federal law, which supersedes the state law, prevents it. So there's no sword over the insurance company's head.

There's no downside to their denying as many claims as possible because the worst thing that ever happens to them and this happens in the minority of cases is that somebody takes it all the way to trial and the judge says pay what you should have paid in the first place. It happens so rarely that the insurance company's actuarially know there's a profit in denying claims.


 Ginsberg: And I mean are those denials, are they automated?



Kantor: Are they automated? No. They are done by people but in our experience, these people are under pressure. They are just individuals doing a job. They are under pressure to make sure they deny or close a certain number of claims every month, whether they should be or not. It's a business model. We need to be closing claims.


Ginsberg: How can we prevent long-term disability denials?  Is there a formula there that we can think about?


Kantor: Well, there are a few things that you need to do but overall what you need to do, is to properly educate your insurance company on why you're disabled typically from your job or for any job you're trained to do, and you need the assistance first of your doctor. If your doctor is not going to support you in your disability claim, then you've got a very tough row to hoe. And  beyond the doctor, you've got to give them all the evidence you can, you also have to give the insurance company an explanation of  what you were doing, such that you have to tie in your physical limitations with your job duties. For example, maybe an airline pilot who develops an eye disease and can't see well, certainly cannot do his job but maybe someone else, maybe a lawyer who doesn't need to see quite the same way an airline pilot does wouldn't be disabled from the same condition.


Ginsberg: All right, so this all comes down to being your own advocate as we were talking a little bit earlier.


Kantor: And to add, you mentioned advocating for yourself with your doctor. That's

extremely important. First, the insurance companies pay doctors to be on staff or pay private doctors and they can pay them a premium to spend their time supporting their denial.


Ginsberg: Wow. Hey, Glenn, we've got to wrap it up here but we will leave it at that very important point  which is get with your doctor and make sure the two of you are teamed up  to make the case for why you need the disability. Glenn Kantor, of Kantor and Kantor, thanks so much for joining us.