In our last post, we finished up our
discussion of the various disability claim forms that must be submitted
when you file your claim. In this post, we will begin our discussion of
the insurance company’s investigation into the merits of your claim.
THE INVESTIGATION BEGINS
Once the initial disability claim forms
have been submitted, the insurer will assign a claims manager to your
claim. Claims managers will have different titles depending on the
insurer. For instance, they’re called Disability Benefits Specialists by
Unum, Provident and Paul Revere, Claims Representatives by MassMutual,
IDI Claims Specialists by MetLife, and Claims Consultants by
Guardian/Berkshire.
The claims manager, often with the aid
of third-party vendors, will begin to gather additional information
about your claim. During the claim evaluation process, you will
typically be required to participate in several interviews with the
claims manager and/or field examiners. The insurance company will also
likely search the Internet for information and content they could use to
deny your claim, and may even hire a private investigator to follow you
around.
Interviews
The insurance company will want to interview you about your claim. The
claims manager may interview you over the phone, or the company may send
a field examiner to meet with you in person at your home or office.
Field examiners ordinarily aren’t employed directly by the insurance
company, but work for third-party vendors, such as private investigation
firms. If a field examiner conducts your interview, that individual
will typically take some time before or after the interview to visit
your workplace (without you) and speak with your colleagues about your
job and your condition. Oftentimes, field examiners will appear at your
house unannounced in an effort to catch you doing something inconsistent
with the information you provided in your claimant’s statement and
other forms.
Since you never know when and where the
interview(s) will occur, you need to be prepared at all times. Although each claimant’s situation is unique, here are
some general tips that can help you avoid prejudicing your claim during
an interview with your claims consultant or a field examiner:
- Ask that that interview not be audio recorded;
- Bring a friend to take notes;
- Be careful of using absolutes, like “always” and “never”;
- Don’t exaggerate;
- If the insurance company wants to interview you over the phone, only talk when you are composed and ready to take notes
Ideally, you should communicate with the
insurance company by mail, rather than on the telephone or in-person,
whenever possible. When things are communicated in writing, there is
less chance for miscommunication, and you will have a record of exactly
what was said, and when it was said. If you have a disability attorney,
you can instruct the disability insurer to direct all communications
regarding your claim to your attorney, and utilize your attorney as a
buffer between you and the insurance company.
Personal Investigation.
The insurance company will scour the Internet for personal information
about you, in an effort to find out more about your daily schedule. In
particular, the claims manager and/or a private investigator will search
social media sites like Facebook and Instagram to see if there is any
information they can use to discredit you, such as recent photos of you
taking a vacation or engaging in activities that appear inconsistent
with your claimed disability. Although insurers generally cannot access
private webpages without your consent, there is nothing stopping them
from finding photos of you on a friend’s public page. And if they find
enough information to suggest that your private webpages contain
information that is relevant to your claim, a court may determine that
your private social media postings are discoverable.
In addition to combing through your
Internet presence, the disability insurance company will almost
certainly conduct surveillance of your home or office. As explained in a
previous post, claim forms often have questions about what you do
throughout the day and ask for a typical daily schedule so that the
insurers’ investigators can schedule stakeouts at optimum times and
locations. Investigators also like to conduct surveillance during family
and social events, such as birthday parties and holiday celebrations,
because those are the times when disabled claimants are most likely to
go out in public and push the limits of their disabilities.
Additionally, if you stated in your
claim forms that you “never” do a certain activity, the insurer’s
investigator will likely follow you around and try and catch you
engaging in that activity. Oftentimes, it will be hard to recognize when
you are being followed, since these investigators are usually former
police or FBI. If you are engaging in any activities that you claimed
you could not perform, and you are caught on tape, your benefits will
likely be terminated.
For more information on the disability insurance claims process, visit our website, www.disabilitycounsel.net or take Ed's CE, Disability Insurance Roulette: Why Is It So Hard to Collect on My Policy?
Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.