Although I’ve been writing about claim “red flags” for about twenty years now, I still see many evidences that insureds and claimants do not give much thought to internal consequences of their behaviors. Of course, this is because insureds don’t know what causes red flags, and unfortunately they keep doing things that create them.
The definition of a “red flag” is the identification of insureds’ behaviors that are regarded as suspicious by any insurance company. As a result, internal risk management activities are assigned to the identified claim until there is no longer any suspicious activity.
Calling an insurance company on the phone frequently is probably the top “red flag” with claims handlers. I’m going to throw in, visiting website portals more than usual also creates red flags and can actually cause denials. Claims reps begin to wonder, “Why is this insured calling me so often? What’s up with that?” “Why does this person have so many questions?” This particular red flag may result in detailed Internet data checks and surveillance, depending on how often the insured actually calls.
Disagreeing, or having questions on every issue raised by the insurance company will also cause a red flag. People who call me seem to be angry about literally everything the insurance company does, even if the company’s actions are legitimate. Another red flag.
A very popular red flag is observing that insureds are not where they are supposed to be. This seems to be a very popular thing with insureds today. Although they are on claimed disability, they appear to go anywhere they want, by whatever means they want, engage in any activity they want, and still expect to get paid for being disabled.
If an insurance rep calls several times and you are not answering your phone, a red flag is raised. It is presumed by insurers that you are working. I keep trying to convince readers and clients that when you claim disability, you have to at least show the semblance of disability. You can’t just keep on doing what you were doing before, and expect to get disability benefits.
Still, insureds continue to travel, and have such busy days that any claims handler worth their salt could probably prove work capacity. Another red flag.
No one really wants to have the lion’s share of risk activity dedicated to their claim, but so many insureds just keep doing what they’re doing and then wonder why their claims are denied. This is why DCS, Inc. always recommended “in writing communications only”, staying off the website portals, and only responding to what is being asked.
I really hope that my readers and Clients take the issue of creating “red flags” seriously by acknowledging that there is a consequence for everything you do when it comes to a disability claims. There are far too many “red flag” behaviors still going on, in my humble opinion.
