Disability Claims Solutions


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wolf in sheeps clothingI had an opportunity to review one of The Standard’s questionnaires, and like many other insurers’ forms, exceeds the limits of insurance investigation in a deceptive way. As always the wolf is hiding in sheep’s clothing in order to mislead insureds into giving themselves work capacity.

One of the basic principles of insurance investigation and claims management, is that information should be added to the file signed by the most qualified resource available to provide the information. For example, patients ARE NOT the best resource to obtain medical restrictions and limitations from. Still, nearly every “questionnaire” I’ve seen asks insureds what their medical restrictions and limitations are. Thinking they have to answer all questions, insureds will attempt to be clever and write something, opening the door to “inconsistency of report.”

Questions concerning medical restrictions and limitations should always be deferred to treating physicians who write them. This is true whether the insured is interviewed by a field representative, or sent a questionnaire. The Standard questionnaire I recently reviewed was six pages long and was sent to an insured who had just recently sent in his application.

About half of the questions typically asked on an insurance questionnaire are for future surveillance purposes. The Standard’s questionnaire for example asks the insured what motor and recreational vehicles they own. Why? What does this have to do with an insured’s inability to perform the material and substantial duties of an occupation?

Another question: “In the past 24 months, or since your disability began (whichever is less), please describe where you have traveled, how you have traveled (car, plane etc.) and how long you stayed?” What? How is this question relevant to a disability claim? It isn’t, except as it relates to future surveillance.

If we go back to the “most qualified source” rule, the treating physician should write on a prescription pad that the insured is restricted from driving and to what extent. Those engaged in sales occupations where traveling is a material duty should always ask physicans to write specific driving restrictions. Again, the “best resource” rule.

Still, I’m finding that insureds are graciously responding to these types of questions in detail because they think they have to. While insurance companies have the right to investigate claims, I’m certain that right doesn’t include banging on doors, breaking and entering, “private trespass”, and deceptively asking questions and playing the odds that insureds are naive enough to provide as much detail as they can.

The truth is that insurance companies actively devise strategies to trick insureds into providing information that discredits their own claims. Insureds need to be very careful when completing forms, deferring insurers to the “most credible source” for answers.

Questionnaire answers should be short and specific, answering only the questions asked without volunteering additional information.