Most of my readers know that I often write about the necessity of abiding by medical restrictions and limitations so as not to provide insurers with “inconsistency of report” that often leads to denied claims.
A case was brought to my attention: Farron Russell Creed v. Hartford Life and Accident Insurance Company, Case No. 2:19-cv-1072 in the U.S. District Court Southern Eastern Division.
Mr. Creed worked for Kenworth Truck Company as an assembly specialist, but in May 2014 was involved in a motorcycle accident in which he sustained substantial injuries. After undergoing several surgeries, he was unable to return to work and filed an LTD claim with The Hartford.
Hartford subsequently approved his LTD claim but on February 19, 2018 Hartford terminated his claim alleging he was no longer disabled under the Plan. Hartford relied on updated medical records, video surveillance, an interview with Mr. Creed, new medical opinions and an employability study.
Mr. Creed’s medical providers provided various documenation that literally did not help Mr. Creed at all. Dr. Taylor remarked, “…Mr. Creed drove to his appointment on his motorcycle“, and notes from his pain management physician, Dr. Patel stated, “…stays active and enjoys his hobbies, especially motorcycle riding.”
Surveillance was conducted. The resultant video from September and October 2019 showed Mr. Creed driving his motorcycle and doing things that he later claimed he could not do – kneeling, bending, stoopiing, reaching and pulling. The video also showed Mr. Creed using his left arm in an unlimited fashion and moving his neck, arms and hand freely.
After the surveillance, Hartford requested a field interview in person and interviewed Mr. Creed without telling him about the surveillance. During the interview, Mr. Creed indicated he could not return to work due to leg and neck pain sustained as a result of the accident. He also said he needed knee surgery to repair a torn meniscus. This information was in complete conflict with the surveillance video obtained before the interview.
Subsequently, as the result of an Independent Medical report, it was determined that Mr. Creed was capable of working 40 hours a week with temporal restrictions regarding standing and walking as well as weight restrictiions and lifting.
The video surveillance was persuasive since it showed Mr. Creed having more functiionality than he claimed possible, and moving in ways that he claimed he could not.
Based on the surveillance and additional medical reports the Judge in this case sided with The Hartford in deciding The Hartford did not act in an arbitrary and capricious manner.
This case is a very good example of the fact that you cannot undo surveillance, or “inconsistency of report”. I want to point out that it is a tactic, or strategy for any insurance company to either do a phone interview, or field visit after conducting surveillance specifically for the purpose of catching inconsistencies.
This is why I have always recommended communications “in writing only”. Unfortunately, some claimants push the envelope too far and do not prevail in court. Those who may think I go a bit overboard with my articles may want to consider this case very carefully. Insureds should never exceed their medical restrictions and limitations. In this day and age it is also important to censor out what you say to doctors about your activities.