Reports of summer surveillance are already coming in to DCS with the potential to deny claims. Although I try to remind readers of increased surveillance, I’m pretty sure most insureds exceed medical restrictions sometime during the summer. The problem is Murphy’s Law also comes into play, and more times than insureds would like to admit, they get caught.
The pattern of practice used by most insurance companies is to send a copy of the surveillance to treating physicians with questions [paraphrased], “So what do you think of your patient now?” Physicians who do not respond at all are directing patients to the claim denial line. Physicians who do respond, must provide a rebuttal of what is seen on the CD, disagreeing with conclusions made.
Surveillance is not just a “begign activity”. It indicates the insurance company is “suspicious”, or has located one or more “red flags” that cast doubt on the claim. Those who say, “I don’t care about surveillance because I don’t do anything wrong”, clearly are in the dark about how this works. It doesn’t matter what you do, or do not do; what matters is how your actions are perceived and misrepresented by an insurance company looking to deny your claim.
Surveillance investigators today are much more agressive than they used to be. Reports to DCS indicate they often bang on doors, trespass on property, turn knobs when you’re not there, and peep into windows. One female insured reported to me that an investigator kept watching her as she sunbathed in her bikini in her yard. It can be pretty scary if you live alone and see big burly men stariing back at you from your front window.
Let’s also not forget that “surveillance” also means an intense Internet investigation, and can include HUB investigators knocking on your neighbor’s doors. As I said, surveillance is NOT an innocent activity and there is always an insurance agenda behind it. In addition, Juries always go for the “seeing is believing” psychology and fail to believe insureds can’t work. Surveillance is a bad thing to have in the record if it goes against the insured.
Although surveillance is a risk activity undertaken at least once on every claim, insureds never seem to get used to the “invasion of privacy” that it implies. But remember, that insurance surveillance is only credible if it is kept secret, or covert. Once insureds “blow the cover” of the van sitting across the street, everyone packs up and goes home.
Therefore, it’s important for insureds to take surveillance seriously and know what to do about it. DCS, Inc. clients are kept well informed about actions that can be taken to sidestep surveillance when it’s identified. For non-clients, my recommendation is to not exceed any medical restrictions and limitations reported to your insurance company.
Surveillance seems to happen when you least expect it. And, when it does, it’s extremely difficult to take back.
