Summer is on the horizon and so are up coming holidays such as Memorial Day, Fourth of July and Labor Day. To say that visual surveillance will certainly be out there is probably an understatement. Although I’ve written many detailed articles about surveillance, I often get the impression they are the least read. I think, though, in this new environment we live in, it’s important to understand insurance surveillance and know how to manage it.
This post is actually triggered by a phone call I received from a non-client who told me how frightened she was to see cars all over her street, people talking to her neighbors, and sneaking around her property. She intimated that she felt surveillance was “illegal”, and now that her neighbors hate her, she should do something about it. “There is no way this can be legal”, she said, “the things they are doing to me are atrocious.
Well….insurance surveillance IS legal and insurance companies have the right to “investigate by observation” anytime they want to to make sure you are reporting your functional capacity accurately. Of course, there are certain boundaries surveillance techs need to abide by, such as no peeking into windows, or knocking on doors demanding to be let in.
Therefore, within certain limits, insurance surveillance is a normal part of the claims process and insureds will either learn to live with it, or will be shaken and stressed out every time it happens.Private disability insurance isn’t the only victim to surveillance since Worker’s Comp, Social Security and Personal Injury litigations are also subjected to surveillance investigation.
While juries adopt the old adage, “Seeing is believing”, it’s well-known that insurance companies misrepresent what they actually observe. While the industry stated goals of surveillance are to observe “functional capacity” and determine if there is “inconsistency of report”, in reality, “what you see is not necessarily what you get.” For example, even though an insured sat down every 10 minutes to rest on the benches at the Mall, being IN the Mall for 4 hours is enough to discredit functional capacity due to back problems.
I wish I had $1 for every time an insured told me, “I don’t care if they conduct surveillance, I don’t do anything wrong.” Clearly, this person does not understand that “seeing is believing” and once an insurance company interprets functional capacity a certain way, IT STICKS.
Therefore, DCS recommends that insureds do not exceed reported medical restrictions and limitations at any time. I’ve been involved with disability claims long enough to know that Murphy’s law does occasionally play out. That one time at the lake when you get on the ski jet, turns out to be the worst possible thing that could happen at the worst possible time. Oops, they gotcha.
Have a wonderful summer, but a SMART one that insures you still have your claim after Labor Day.
