This article could be considered an addendum to the last one I wrote regarding surveillance. Since my last article on the subject, additional reports have come to light making insurance surveillance the number one risk management tool to terminate claims.
Lincoln Financial seems to be the current leader of the pack despite the fact that the reported/observed activity amounts to little more than walking your dog, not using your cane, and not staying in bed all day.
The ridiculousness of the surveillance causes problems all the way around. “Walking a dog” DOES NOT prove full-time work capacity even though Lincoln may think it does. Still, the insured with a denied claim will be waiting a minimum of 6 months to a year before an appeal decision will be made. Seems to me, any insurer will have gotten what it wanted, namely a contribution to profit in the time period the company needed it.
Let me make this clear. Restrictions and Limitations reported to the insurance company cannot be violated-EVER. Some insureds seem to think it’s OK to over restrict themselves and then go about performing the same level of activities while on disability. Someone called me to say they traveled to the west coast to see a new grandchild, and did I think they would get caught. Still another wanted to know if her claim would be denied if she travelled to Florida to see her daughter. Ongoing are questions about playing golf and other sports like tennis.
The aftermath of COV_D opened the doors for insurers to “get out there” and start engaging in a three-day tag surveillance, not to mention all of the time spent investigating insureds’ presence on the Internet. Again, bragging about the family vacation on Facebook, complete with pictures of the ski jet isn’t a good idea. Neither is being caught in a waist towel at the local gym after a workout.
The bad part about being observed during a surveillance is that if an insurance company really wanted to, they could go to your state Attorney General and report you for insurance fraud. If you report a walking restriction of not greater than 10 minutes and then walk your dog two miles, then the restriction is not correct. Any judge or jury would reasonably conclude that.
In my opinion, insureds are really pushing the envelope with R&Ls increasing the probability of getting caught. If I had an IDI claim of $10,000/month I’d really think about that. Was that tennis match worth it?
I really hope insureds are taking these articles seriously. It only takes one surveillance to do you in. Of course, my recommendations include NOT exceeding medical restrictions and limitations. If you want more freedom to be active, report your functional capacity that way. Don’t report your R&Ls like you were ready for a Hospice, and then go play tennis. It won’t work for very long.
