While this usually comes to the surprise of most people who are currently receiving long-term disability benefits, your insurance company is not your friend. They are providing you with long-term disability benefits because they are contractually obliged to, not out of some sense of altruism.
Not only are they only doing what they are contractually obligated to do, they are also constantly reevaluating your entitlement to ongoing long-term benefits and actively seeking excuses to disentitle you to benefits or to void coverage under your insurance policy.
Your Medical Records and Independent Medical Examinations
Your insurance company will be continually looking through your medical records from the start of your claim until the claim ends to look for ways to deny paying further benefits and to confirm you still meet the definition of “disabled” under the terms of your long-term disability policy.
In the beginning of your claim for long-term disability benefits your insurance company will look at your medical records from before you applied for insurance coverage to see if they can find any misrepresentations or fraudulent statements you made in your insurance application. The reason for this is if they can find a material or fraudulent misrepresentation, they can void your policy saying it was entered into under false pretenses. This way they don’t have to pay any benefits.
Assuming you pass the first hurdle and your long-term disability benefits are approved the insurance company will still be combing through your medical records to ensure you are regularly attending a doctor and following their advice. If your handling insurance adjuster can find anything that they can use to deny further benefits. If they think they may have an angle to do so they will set up what is called an independent medical examination (or IME).
Most insurance policies include a provision that allows your insurer to require you to attend a independent medical examination in our for your long-term disability benefits to continue. These are medical assessments by hired experts in a medical specialty that relates to your disability. So if you’re disability is psychological in nature your insurance company may schedule an independent medical examination with a psychiatrist or psychologist, or if your disability relates to a broken bone they may schedule an assessment with an orthopedic specialist.
Generally speaking, the doctors who perform independent medical examinations make a lot of money from doing so and are well aware that the client who is continually hiring them is the insurance company. As such these doctors are incentivized to provide the insurance company with the answers they want, namely that you are no longer disabled under the definition of the policy. So if your insurance company requires you to attend an independent medical examination be on your toes and, while you should never exaggerate, be honest and don’t underplay your disabilities. While it is never fun to focus on what is disabling you, if ever there was a time to view your disability with brutal honesty, an independent medical examination is that time.
Weekly/Daily Diaries & Private Investigators
Another way insurers seek to deny your long-term disability claim is by looking at your activities of daily living by asking you to provide a diary of what you do in a day, usually for a period of about a week. While your insurance adjuster will likely couch this request as if it’s simply a standard part of the continued evaluation of your ongoing disability claim. The reality is that during the week they have requested you to fill out an activity diary your insurance company will likely be hiring a private investigator, or a independent adjuster, to follow you around and take surveillance video of you to see if you’re actually doing what you write in the diary. If you’re doing something different for what you wrote that may be a basis for your insurance company to void your insurance policy.
Insurance Company Surveillance in the Digital Age
With the leaps and bounds that technology has made over the years there are many new ways for your insurance company to keep an eye on you. Some of these you may have thought of but others may surprise you.
SOCIAL MEDIA
The obvious way insurance companies keep track of your activities is through social media. Whether it’s through Facebook, Instagram, Snapchat, TikTok or any of the other social media networks out there, most people leave a digital footprint of some sort out there and the insurance companies are watching. The insurance companies have entire teams dedicated to combing social media for photos and videos on your social media that could impact your insurance claim. They have special expertise in getting to your posts, even if your privacy settings are up to date.
The Courts have already ruled that people put their best face forward on social media and that it shouldn’t be taken to be reflective of a person’s real life. While your social media posts may not win or lose your case at court, it could sour the insurance company on your case and drive it to a trial when it otherwise may have settled.
There are new social media sites popping up every day, but some of the more well-known ones are:
SMART WATCHES & WEARABLE TECH
A relatively new area of insurance company surveillance is the meta data caught by smart watches and other wearable tech. While this information isn’t producible pursuant to most current insurance policies, if you start a lawsuit you have an obligation to produce all relevant documents and information. Most smart watches keep track of your movements and the amount of walking you do during a day, including when and where you do it.
Insurance defense lawyers have recently started requesting this meta data in legal cases and it is likely production of this information will become increasingly more common. While it may seem invasive, many insurance claims deal with functional ability, which is a metric that wearable technology tracks.
If you have an insurance claim it is wise to disable any such tracking ability on your wearable or smart technology to get ahead of any issues with production of this data. You don’t have to produce that which doesn’t exist.
Insurance Denial Lawyers and Claim Investigations
If you think your insurance company has been investigating your claim contact our experienced insurance denial lawyers at Taylor & Blair LLP today.