Surveillance is a frequent tool used by disability insurance companies to try to deny or terminate claims. We often hear from claimants: "I have nothing to worry about, because I am actually disabled. Let them follow me;" "I would know if I were under surveillance;" and "my claim is not worth enough for my disability insurance company to pay to surveil me." Unfortunately, these common misconceptions about insurance company surveillance all too often result in claimants being stunned that their truly deserving claims have been denied or terminated.
Many group and individual disability insurance policies provide protection in the event that a claimant cannot perform the material duties of their Own Occupation ("Own Occupation Period") for a limited period of time (typically 24 months). In many policies, after the Own Occupation Period expires the definition of Total Disability changes to the inability to perform the duties of any gainful occupation ("Any Occupation Period"). Occasionally, this definition will include an Earnings Qualifier, which means that if the claimant can work in another occupation, but cannot perform the duties of an occupation that would allow him or her to earn a certain percentage of their pre-disability income, they would still be considered Totally Disabled.
As those who suffer from medical conditions such as fibromyalgia and chronic fatigue syndrome know, these illnesses can incapacitate an individual physically and mentally. No current treatment has proven totally effective against these infirmities and in many cases the illness becomes worse over time. Many clients come to us at DI Law Group complaining that despite having provided their insurance company with medical evidence proving that they are no longer able to work, the insurance carrier has either failed to make a decision and is "surveillance" the claim or has unfairly denied benefits claiming there is insufficient evidence upon which to grant benefits. One such client, "Ms. Doe", a professional who truly enjoyed her occupation and worked as long as physically possible, contacted us after her claim for benefits had been unfairly denied by Prudential. Included with her application were medical records with examination findings confirming her medical diagnoses and detailing her physical limitations and decline. During its investigation of the claim, Prudential put her under surveillance, sent her ongoing requests for information, had one of their own "independent" physicians review her medical records and the surveillance tape, and misrepresented her occupation and limitations to the vocational specialist assigned to review her claim. Not surprisingly, Prudential's physician determined that there was no medical evidence to substantiate her reported complaints of pain, fatigue, and limitations and thus found that she could return to her job on a full time basis.
It is often difficult to get a disability insurance company to accept liability of the claim, when a claimant suffers from a condition that is not readily diagnosed by objective testing. Insurance companies frequently target conditions such as fibromyalgia, chronic fatigue syndrome, depression, chronic migraine headaches, and even multiple sclerosis, rheumatoid arthritis, and back conditions for denial based on a lack of objective evidence. Even where there is clear objective evidence of the condition, such as a herniated disc that appears on MRI suggesting degenerative disc disease or white matter in the brain indicating multiple sclerosis, insurance companies will often challenge the claim for disability, arguing that there is not objective evidence of functional impairment indicating a disability from work.
Your disability insurance claims examiner is not their friend and the information you provide to them can often be misrepresented and used against you. It is essential to remember that insurance companies have an inherent conflict of interest in that they are responsible for making the decision on whether you are eligible to receive benefits and they are the party responsible for having to pay the benefit if you are approved. Ultimately, insurance companies are for-profit businesses that earn money by denying claims. For this reason, disability insurance claims are highly scrutinized and often fiercely litigated. Claims examiners work for insurance companies and they are trained from the beginning to ask questions in such a way to elicit certain information. No matter how pleasant and caring they seem, they are not there for your benefit. While your claims examiner may actually be sympathetic to your condition, their hands are tied by the insurance company. Each insurance company creates their own rules and procedures which, claims examiners must follow to "investigate" claims. Their work is closely monitored by supervisors, conversations are often recorded, and they are expected to follow protocol. Accordingly, it is essential that you are not caught off guard or lulled into giving answers that can be misconstrued or taken out of context. This is one of the most common insurance company tactics. Be aware that what you say and how you say it can be used against you and that your claims examiner has been trained to seek out certain responses and to evaluate information provided in a light most favorable to their employer.
Your disability insurance company could be stalking you on Facebook. Be careful who you Friend or what you post on the internet. Insurance companies have become extremely savvy in how to use social media to "investigate" and ultimately deny insurance claims. Facebook, on-line dating sites, and other social media sites are now the norm in our culture. However, often internet personas and profiles create a skewed image of an individual's abilities and activities. Accordingly, insurance companies scour the internet to find any glimpse of a claimant in order to create the illusion that they are more active than they and their doctor's have indicated. This is one of the most common insurance company tactics, which often results in truly disabled individuals losing their insurance benefits.
Disability insurance companies often employ common insurance company tactics when investigating a claim or claimant. Insurance companies are businesses that profit when insurance claims are not paid. Accordingly, they spend a significant amount of money each year scrutinizing claims, in an effort to maximize their bottom line. Knowing the common insurance company tactics utilized by your carrier may save your claim.