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Did you know long term disability insurance companies commonly use surveillance and other tactics to deny claims?
Of course long term disability benefits are a last resort, and you wouldn’t be on claim if you could work. But insurance companies don’t always see it that way, and are constantly looking for reasons to deny claims. This blog post will cover some of the most common tactics used to deny claims.
Tactic 1: Creating Inconsistencies With Surveillance
After a claim is submitted, a representative of the insurance company will almost always conduct a telephone interview. It will either be recorded, or detailed notes are kept. The discussion may seem relaxed and conversational, but the adjuster wants to secure your evidence regarding what restrictions and limitations you have; that is, what you can and cannot do. Questions may be along the lines of “How long can you walk?”, “How much can you lift?”, “Do you have any hobbies?”, “How long can you do those hobbies?” You answer the questions truthfully and honestly, but without too much thought.
A few weeks or months later, the insurer may ask you to complete a log of your physical abilities. Or maybe it asks for a detailed list of activities you complete each day. Again, you answer the questions truthfully but without too much thought.
The insurer will compare the information provided on the phone call with the information provided in the forms you completed. Chances are there will be some small discrepancies. The LTD insurer may consider these minor inconsistencies to be “red flags”.
The adjuster is now suspicious so pays a private investigator thousands of dollars to conduct surveillance of you. This may seem like spying, but they are allowed to do it. In fact, it is quite common. A few months may have gone by since your telephone interview. You may have said you rarely leave the house. After several days of unknowingly being watched by a private investigator, you drive to the grocery store, attend a gas station, and go to an appointment. Maybe you were more active the day of surveillance than usual, but the adjuster now believes you are capable of doing more than initially thought.
Have you done anything wrong? Of course not. Did you lie or exaggerate to the insurance company? No. Will the insurance company think you are overreporting your symptoms and underreporting your activity level? Probably.
As a long term disability lawyer who has successfully resolved hundreds of denied claims, I can confidently say the surveillance evidence relied on by insurers to deny claims is very rarely as strong as they think it is. Often, surveillance is used as an excuse to deny, even though it would not even be admissible in court.
Tactic 2: Social Media
Similar to the surveillance example above, insurance companies will secure as much information as they can about your activity levels, and then cross reference that with social media and other online searches. Pictures of you smiling on Facebook or Instagram are not usually a problem, but if you appear to be more active overall than you report the insurer, that could be an issue. Travel while on a disability claim could also be a breach of the policy, or at least make it look like you are not really suffering. Be careful what you post online and consider adjusting your privacy settings.
LinkedIn can also create problems. Maintaining and updating your profile, and presenting yourself to the world as an ideal job candidate may give the insurer the impression you are ready, willing, and able to work, even if that isn’t the case.
If social media played a role in your claim being denied, consider a free consultation with a long term disability lawyer.
Tactic 3: Misinterpreting Medical Records
If the long term disability insurer is paying your claim, then it accepts you are “totally disabled” as defined in the policy. While on claim, your family doctor may ask how you are felling and you may say there has been some improvement. Your doctor may not write down exactly what you said, but instead paraphrase with a brief note that simply states “doing better”. The insurer sees this note, takes it out of context, assumes you are no longer disabled, and denies your claim.
Of course this is unfair – one clinical note taken out of context doesn’t mean you can work. But as a long term disability lawyer, I routinely see clinical records of treatment providers taken out of context by long term disability insurers. It is also very common for insurers to ignore mountains of evidence that supports disability, and instead rely on one or two minor points to justify denial.
There are of many more tactics and tricks used by long term disability insurance companies to deny claims, but these are some of the most common. If your long term disability claim has been denied, be sure to seek legal advice from an experienced LTD lawyer.
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