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How Insurance Companies Use Surveillance To Deny Disability Claims

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If you have recently filed an individual or long-term disability insurance claim, it is likely your insurance company will run surveillance on you when you are in public. While the thought of being recorded and photographed is unsettling for many, it is an unfortunate reality of insurance claims investigations.

Here are several factors to consider about the legality and practical use of surveillance to discredit disability claims.

Surveillance: is it legal?

Many policyholders rightfully question whether it is legal for their insurance company to conduct surveillance on them. The answer depends on how and where the surveillance happens.

Insurance companies are entitled to evaluate the validity of the information submitted in your claim forms, and will often do so by shadowing you in public to determine if there are inconsistencies.

Therefore, if you are in public - such as driving, shopping, at dinner - it is legal for insurance companies to record and videotape you, as there is no reasonable expectation of privacy when you are in public.

However, if your insurance company trespasses on your private property to videotape or photograph you, they are conducting surveillance illegally.

Insurers may also use field visits as a form of surveillance, in which the company hires a representative to meet with you face-to-face to talk about your benefit claim at your own home or office.

While these field visits can seem innocuous, insurance carriers often have other motives for entering your office or home:

  • To take your picture/find out what your home or office looks like to aid the investigator in surveillance
  • To look around for evidence that you have been doing housework, paperwork, etc. that should be limited by your disability, or if you can sit down, walk, etc. for extended periods of time
  • To get you to relax or catch you off guard and provide information the company can use against you

Learn more about the implications of submitting to a field visit.

It is also important to note that it also legal for insurers to conduct surveillance on you more than once if the first attempt does not yield the compelling evidence they seek.

The reality of insurance fraud

The Coalition Against Insurance Fraud estimates fraud steals $80 billion a year across all lines of insurance.

Insurance companies have a financial responsibility to their stockholders to pay only legitimate claims, which is why many use surveillance to identify and deny fraudulent claims.

Insurance fraud can also have negative impact on other policyholders. According to the FBI, insurance fraud can cost the average American family between $400 and $700 each year in the form of increased premiums.

While unscrupulous people do make fraudulent claims for secondary gain, insurance companies often use the pretense of fraud to deny legitimate insurance claims. This is often seen in high-dollar individual disability claims.

After all, insurance companies are businesses, and as such, they aim to be profitable. One source of insurance profitability is the earnings from non-payment of claims, and surveillance is a common risk management strategy that can make the termination of these claims look credible.

How insurance companies use surveillance

When you filed your claim for long-term disability benefits, your insurance company likely asked you to specify which activities you can no longer perform due to your disability. The insurer may have also asked you to complete an activity log detailing your typical daily activities by the hour.

While this information can provide a clearer picture of your disability, insurer can also use it to invalidate your claim.

The activity log can help insurers identify your daily schedule and determine where they can observe you in public.

Then, the investigator will try to catch you performing activities that should be limited or prohibited because of your disability. This "evidence" can then be used to deny your claim. In some cases, the insurer could also allege the claim was fraudulent and rescind your policy.

If you have been requested to participate in an independent medical exam (IME), the insurer may order surveillance to be conducted the day before, the day of and the day after the exam. This will allow the insurer to directly compare your public behavior to your exam results and look for any inconsistencies in symptoms or limitations.

Beware of social media surveillance

Over the last several years, insurance companies have increasingly relied on social media to investigate policyholders, as it can provide opportunities to uncover information that may conflict or contradict information presented in your insurance claim.

While social media is an excellent resource in uncovering insurance fraud, it can also be used against those who have legitimate claims.

According to an article by insurance company GenRe, social media investigation is an increasingly popular form of surveillance because "Monitoring these sites is a cheaper and quicker way of gaining insight into a claimant's activities and domestic situation than arranging surveillance of a home visit. Theoretically at least, it also provides an opportunity for a more genuine appraisal of the true level of functional capacity."

Harvard neuroscientists say we cannot help but share our thoughts, which often leads to oversharing on social media. Unfortunately, these habits can pose a problem for the fate of an insurance claim

Claims investigators may combine traditional surveillance findings with your social media activity to build a "history of behavior" that supports their assertions and invalidates your claim.

They may also directly compare the language you use in your claim forms to your social media activity; if you report you are never able to lift more than 20 pounds but a picture on social media shows you carrying around a small child who clearly weighs more, your claim could be denied.

In many cases, the assumptions drawn from your social media activity may be unfair or inaccurate, as people often show only a small and "cleaned up" version of their life on social media. However, any information you willingly share with the public can and will be taken at face value by insurers and used against you.

What can you do about it?

If you discover your insurance company has run surveillance on you and is attempting to use this "evidence" against you, do not be intimidated. An experienced long-term disability insurance attorney can help you determine whether the insurance company illegally followed you or misconstrued their findings to construct a false narrative about your disability.

You can also safeguard against social media surveillance with a few simple steps. Learn more about auditing your social media use after filing a disability insurance claim.

When legitimate claims are denied

If you have filed or are preparing to file a long-term disability insurance claim, or believe your benefits have been wrongfully denied, contact our top-rated long-term disability insurance attorneys for a free consultation.

There is no risk involved in contacting DarrasLaw; if you have individual or long-term disability insurance questions, our legal team is here to help.

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