Disability Claims Solutions

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Surveillance3All insurance surveillance initially begins with a red flag determined by the claims handler, whether it be conflicting or lack of medical information, inconsistency of report, or any number of other conflicts in a claim that challenge credibility of it.

A referral is made to an investigative section of the insurance company, or, most often today, to a facility such as G4S, or THE HUB to conduct a three-day surveillance most notably Thursday, Friday and Saturday. A “tag” surveillance can also be requested, which is a surveillance conducted the day before, the day of, and the day after a field visit or IME. Most surveillances are conducted for a maximum of three days at time. No insurance company I am aware of orders indefinite surveillance for weeks at a time – it’s far too expensive.

Most surveillances also include an “activities and data base check” allowing surveillance teams to “hack into” social media, and obtain information about activities. Social media investigations such as for Facebook, LinkedIn etc. go back three generations e.g. your friends, and their friends and their friends, friends. Relatives are targeted three generations to great grandparents if they are still alive.

Insureds who are unsure they are being watched may telephone the local police to ask if “anyone is doing surveillance in the neighborhood”. Local police may or may not tell you, but you can encourage your neighbors to also call and say, “there’s a stranger parked on my street and I’m fearful for my kids.” Then, the policy may do something.

Courthouse and town office records are obtained to include license information, real estate owned, recreation vehicles registered etc. Most information in public domain is obtained and documented for the file. Most insurance companies can obtain more information about you without your signed Authorization than they can with it, which is something to think about. There is no expectation of privacy these days, and clearly insureds are not afforded any particular protection from public domain information.

Some insurance companies such as The Hartford, Berkshire, and Mass Mutual may request investigators visit your neighbors, former peers, etc. to obtain information about your activities, therefore from the beginning “surveillance” is much more than spying, and sitting in vehicles in front of homes. Although investigators are not permitted to set up cameras or spyware on your neighbor’s property without permission, insureds would be surprised at how easy it is to obtain that permission. Do we really know our neighbors?

The truth is, “insurance surveillance” is a probable certainty for insureds. It is the second most profitable “risk management activity” contributing millions to the corporate coffers on a yearly basis. (IMEs are the first.) Surveillance is a legally “justifiable” activity that allows any payer of benefits to insure the honesty of the person to whom the benefits are paid. Although surveillance isn’t conducted all the time, insureds can make a sure bet that the probability of being surveilled is more likely than not.

No disability claim is actually denied with Plan or policy citations that involve surveillance. BUT, observable evidence can be used to otherwise bolster a weak claim for denial. Nearly all claims on which surveillance is conducted are denied “for not meeting the definition of disability” IN THE OPINION OF THE INSURER BASED ON SURVEILLANCE.

In most instances there are between 1-3 vehicles following you or watching your movement. Investigators can track you by getting into your GPS and phone location software. At the end of three days of observation, the surveillance is terminated and a report is generated containing the results of every category of investigation. I am told investigators now have video equipment that can record up to 400 yards or better. You may not see who’s watching you.

If investigators are unsuccessful “seeing you” they will call your house and use a “ruse” that there is a package delivery, “Will you be at home?” There are many good shams used by investigators to locate you during the surveillance, although modern day tracking is a much more efficient way of “finding people.”

When all else fails, some investigators storm the residence, unannounced, and demand entry for an interview. Insureds are well-aware of this possibility and, of course, refuse to participate in a sudden, forced demand to gain entry to residences. I recommend putting small “NO TRESPESSING” signs on the property so that unsolicited investigators can be reported, particularly if they have been banging on your door.

In addition, depending on the investigative company, there are “tricksters” out there who set up elaborate shams in order to entice observable activity that exceeds medical restrictions and limitations. Investigators have been known to follow insureds while they are in the supermarket, fitness club, doctor’s office,  rest rooms, and many other public places. Seeing the same car, same faces, is again a clue to surveillance taking place.

When the surveillance is terminated after three days, a report containing all of the data information along with a DVD is provided to the claims specialist. On occasion, the DVD is then provided to treating physicians with a question, “Well, what do you think about your patient now?” A small percentage of physicians DO change their minds and drop patients when activities observed on the DVD differ from what the doctor reported.

Finally, the surveillance report is also reviewed by a claims manager, and if the claim is presented to a roundtable, many people within the insurance company will also have access to the surveillance DVD. There is no such thing as “privacy” when you have a disability claim.

Those people who tell me, “I don’t care about surveillance, I don’t do anything wrong” clearly don’t get what’s happening to them. Insurance companies have a way of interpreting DVD activity in ways that suit them.  A good example is, “the dog walking” scenario  interpreted as work capacity even the dog was walked for less than 10 minutes!

One of my clients called me from his car to say that he was being surveilled. When I asked what he was doing he said, “I’m doing all my errands now.” Oops! He really needed to go home and stay there.

In conclusion, the purpose of surveillance is to “catch” insureds engaging in physical activity that exceeds the exertion levels of his/her own job, or after 24 months, the demonstrated ability to perform ANY job. Surveillance is interpreted any way the insurance company chooses to interpret it. And, while claims usually aren’t denied on surveillance evidence alone, it is always used to challenge the credibility of insureds simply by its nature -“seeing is believing”, particularly in front of a jury.

Surveillance is a way of life for those who are receiving disability benefits. There is no expectation of privacy. Insureds need to be prepared for it and have a plan to deal with it. A known surveillance shouldn’t be ignored as, “I don’t do anything wrong” because all surveillances are interpreted as “doing something wrong.” Stay off of the Internet, and remember that anything you write  there will be seen globally – forever.

Unfortunately, insurance surveillance adds to the stress and anxiety of having a disability claim at all. All agencies now conduct surveillance including SSA, Worker’s Comp, Personal Injury, as well as disability claims, and all agencies have access to modern technology.


EPILOGUE

If you are walking along a crowded street and someone steals a purse, it is likely that a minimum of 25 people will have recorded the incident on their cell phones. There are surveillance cameras (CCTV) on nearly every block, in every parking lot, and store. I don’t even want to get into how many eyes are watching social media, texts, and with the help of Alexa, are monitoring what’s going on in our homes.

While insureds tend to expound on the unfairness of insurance surveillance, the truth is that we are all “watched and listened to” probably more than we realize.