The short answer to the title question is:
Occupational, Medical and Financial information. Yes, claimants and insureds have a responsibility to provide certain information, but there is information NOT REQUIRED to be given, such as: daily activities, computer usage, gardening, laundry, nap time, and driving etc. These questions invade the “living space” of insureds for the purpose of surveillance where a case can be made for “inconsistency of support.” There is a direct correlation between excessive information giving, and claim denial rates.
Because “activity” questions are asked on forms that appear to be official, most insureds go ahead and answer these questions as if they are generic and harmless when they are anything but. There seems to be a great deal of confusion out there as to what information is required, and what is “risk management”, hence, I’m writing this article.
Since all policies and ERISA Plans define disability as an “inability to work”, occupational information must be provided to insurers. ERISA employers are generally asked to provide official Job Descriptions and IDI insureds should always make sure they provide a detailed Curriculum Vitae, or Job Description.
I want to mention something here that many people are probably unaware of. ERISA Plans DO NOT INSURE anyone’s JOB. They insure the OCCUPATION as defined in the National Economy. Although there may be tasks employees are asked to perform, the actual job IS NOT insured, but only the Occupation is.(This is a much more detailed subject for another day.)
IDI policies with state jurisdiction DO insure the JOB, which is why it is so important to provide insurers with detailed job descriptions. Nevertheless, I have always recommended that ERISA claimants also submit detailed Job Descriptions to the Administrative Record especially if the employer’s JD is significantly different that the actual job.
Second, both insureds and claimants are required to provide earnings information. ERISA Plan benefits are based on pre-disability earnings, and IDI policies require verification of occupation just prior to date of disability. This doesn’t mean that both groups of insureds have to provide unlimited information, such as tax returns. DCS, Inc. takes the position that tax return requests at the time of IDI application, and yearly returns for those working part-time are reasonable. If the ERISA folks aren’t working, then the requests are NOT reasonable and can be challenged.
Medical information is a common sense given. Many of you know I have said consistently thousands of times over the years, “No medical, no claim.” Insureds and claimants should always provide the best medical information that one can afford.
This leaves out much of the other information claimants are asked regarding their activities. The ability to perform Activities of Daily Living is a fair question and should be answered. Beyond that, all of the questions about daily activities are asked for the purpose of determining “work capacity” you give yourself,, which is the best kind to deny a claim for. “How much you sleep during the day”, or “use the computer”, or, “whether you go to Church” are questions that can easily stack the deck against you.
The number one answer that causes denials is the one about babysitting for grand children, with a close second answering questions about fertility counseling and trying to get pregnant. Insurers use “activity” information to calculate METS, which in turn is alleged to be work capacity.
Those insureds and claimants who may think that giving as much information as possible could find themselves in situations where “red flags” are created and claims are eventually challenged or denied.
Regardless of what your opinion is on giving insureds more information than they need, my recommendation is to be truthful and provide all information required, and not a syllable more.
