Disability Insurance Claim Advice
VIDEO SURVEILLANCE & FIELD INVESTIGATIONSt
Health Insurance Underwriters (N.A.H.U), April 2006
By Art Fries
Any one of video surveillance and field investigations provides a basis for an insurance company to deny or terminate a disability claim.
A policyholder (claimant) must be well-versed in the intricacies of each of these insurance company “weapons” in order to level the playing field in the game of disability claims. These are the areas whereby a disability carrier tries to crawl in a crack and make it wider, or get water out of a stone.
Because of time restraints and not wanting to put myself out of business by providing too much information on the subject, I will provide a taste of what each weapon means.
The insurance company uses an outside source to determine if your personal activities are consistent with your symptoms. Example: A Surgeon with a lower-back problem who is skiing would demonstrate an inconsistent activity. Video surveillance is done at your residence or office with a parked van monitoring your activities or a car following you-or both. This monitoring can be for three to five days but I have seen instances for much longer periods of time in which the claim involved several million dollars of benefits.
A representative comes to see you with or without an appointment. This could be an employee of the insurance company or from an outside service. The purpose is to see if your answers to questions are consistent with answers provides on claim forms. Sometimes a handwritten statement is give to the claimant with a request to read, sign, date and give back to the investigator. There are other purposes of this visit, which are too many to mention in an article of this size.
Independent Medical Evaluations
The insurance company sends the claimant a letter indicating the individual who will be doing the exam, as well as the date, time and location. This can be an MD, psychologist or psychiatrist. The claimant must be well prepared for this exam by knowing what to do in advance, as well as what to look for at the exam.
Functional Capacity Evaluation
This is a test given by a physical therapist that can take three or four hours. The purpose is to inflict pain and see how much of it you can handle. Most disability policies do not permit this test but insurance companies don’t tell you this. There are clever ways in which insurance companies go about seeking this test. If you know how to respond to the insurance company, you can avoid such a test.
The above weapons used by insurance companies can be used multiple times over the life of a claim. Being well prepared for this battle can mean the difference between you being in a state of apprehension and a state of control.