Recently the United States District Court for the District of Colorado determined an insurance provider wrongfully terminated a client's long-term disability (LTD) benefits. Paquin v. The Prudential Insurance Company of America highlights potential issues for others receiving benefits for an extended period.
Insurance companies frequently use private investigators to place claimants under surveillance while "investigating" a claimant's right to disability insurance benefits. Surveillance is conducted at various stages in the disability insurance process including, when a claim is filed, periodically throughout a claim if benefits are approved, and after a claim has been denied. Very often, the activity actually captured on video is not inconsistent with a claimant's stated activities. However, frequently, insurance companies will piece together snapshots of activity, over the course of several days and/or months to create the illusion that the claimant is more active than they have asserted. Private investigators have the power to turn on and off their camera while surveilling a claimant. This gives them significant power to create the illusion that the claimant is less limited than he or she previously claimed. For example, private investigators only shoot footage when the claimant is actually active. If the claimant fails to leave their home for two or three days, the video footage will never capture this, despite the fact that it may be consistent with the claimant's stated limitations and compelling evidence of disability. Similarly, video surveillance footage cannot establish the degree of pain a claimant was in when engaging in the activity seen or document the amount of pain medication the claimant had to take when he or she returned home.
Recently, more and more disability insurance companies are denying claims on the basis that the individual or employee is not covered under the policy. More specifically, insurance companies are asserting that at the time the individual became disabled the policy at issue did not cover them because the person was not part of a covered class; became disabled just before or after their company changed policies and was therefore precluded from coverage due to a pre-existing condition or because the new coverage had not yet taken effect; because they were not Actively Employed; and/or for a myriad of other coverage related reasons.