As a disability Consultant, I have always recommended that insureds and claimants request communications from insurers in writing. Despite this common “best practice” many insureds continue to communicate directly with claims reps, and/or OVERWRITE answers to questionnaires and inquiries. Those who don’t listen to the people who know eventually find their claims in trouble.
I want to be very clear about the fact that most insurers’ questionnaires are wolves in sheep’s clothing enticing you to give yourself work capacity without knowing it. Although the questions appear innocent enough, all “activities” questions have to do with interpreted functional capacity that you gave yourself. What better evidence to deny claims than what you say yourself?
To begin, in my opinion, insurance questionnaires ask questions that exceed the authority of investigating claims. For example, why would Prudential need to know if you “Read” or not? Or, what you read. This question is intended to check “cognitive ability”. If a claimant reported “cognitive deficits”, then the ability to read and hold attention is limited. This is why Prudential follows up with: “How long do you read?” Or, “How long are you on your computer?” (Prudential is particularly clever in misrepresenting functional capacity via questionnaires and mental health records.)
Claimants reporting the equivalent of “brain fog” shouldn’t be reporting cognitive functioning requiring concentration, particularly for long periods of time.
Claimants who report “Yes” to questions concerning laundry and gardening are giving themselves between 5-10 METS of functional capacity equal to at least sedentary work capacity. Most claimants facing change of defintion at 24 months need to be very carful about voluntarily giving themselves sedentary work capacity.
A few insurers also ask questions about hobbies, and visits with family. Reported “hobbies” opens up doors for investigators to search social media for information about what you do and for how long. Visits with family in combination with traveling information could also be misrepresented as “work capacity.”
Claimants seem to develop very bad habits when it comes to filling out insurance questionnaires. Some, downsize their handwriting so that every possible fact, activity and figure can be written in – a mistake they later learn to regret. For every questionnaire answer given by an unsuspecting claimant, there is a misrepresentation of work capacity on the other end. Less is more!
A large percentage of questions are also aimed at establishing “inconsistency of report”. First, the claims handler will request a phone call and ask the same questions you already answered on the questionnaire. Then, surveillance is requested to observe if what you told the insurance company is accurate.
Some time ago it was reported to me that Unum added questions about sex to its phone interview template. Insureds don’t need to answer personal questions like this and should just say, move on. (Or, I’d be tempted to say “Stick It!”) But, I’m sure you get the idea. This includes questions concerning attending Church as well, which is also asked to determine functional capacity.
My point is that insurance questionnaires are NOT benign, information-seeking updates to continue paying you. In fact, they are quite the opposite. Insurance questionnaires rely on your own answers to voluntarily give the insurance company proof of work capacity.
Great care must be given to making sure answers are truthful, and yet do not give away the farm.
