The BenGlassLaw long-term disability team was able to secure a $50,000 settlement even after the claimant was caught on video doing things she said she could not do.
This was a very tough case where the client had been “caught on video” doing things the insurance company felt were inconsistent with the complaints she was making and the reports her doctors were writing. We were able to settle this case on the eve of the hearing to determine whether the insurance company was right or wrong.
The Use of Surveillance by Long-Term Disability Companies
When managing long-term disability claims, insurance companies are vigilant in ensuring that the information provided by claimants is accurate and truthful. One of the common practices used by insurers to prevent and detect fraud and misrepresentation is surveillance. This method involves discreetly monitoring the claimant to verify the severity of their reported disability. Surveillance might include video recordings, photographs, and even social media monitoring, which are used to observe and document the claimant’s daily activities. For example, if a claimant reports severe back pain that severely limits their mobility, but is then recorded lifting heavy items or engaging in sports, this evidence can be used to challenge the validity of the claim.
Insurance companies may also employ other techniques to detect fraud. These include:
- Data Analysis: Advanced data analytics can be used to identify patterns that may indicate fraudulent activity. Insurers analyze claims data to find anomalies or inconsistencies in the history of claims.
- Medical Record Reviews: Insurers often conduct thorough reviews of a claimant’s medical records searching for discrepancies or inconsistencies between the claimant’s reported limitations and their medical history.
- Interviews and Questionnaires: Claimants may be asked to participate in detailed interviews or to complete questionnaires that can help insurers gather more information about the claimant’s condition and daily activities.
- Independent Medical Examinations (IMEs): Insurance companies might request an IME to get an independent opinion on the claimant’s medical condition. The IME doctor will assess the claimant to verify the extent of their physical or mental impairments.
The use of these techniques underscores the importance for claimants to be completely honest and accurate in all communications with their insurance company. Any discrepancy found between what a claimant reports and what is discovered through surveillance or other investigative means can lead to a denial of the claim, as well as legal consequences for insurance fraud. This not only affects the individual’s claim but can also lead to broader legal and financial repercussions. Therefore, maintaining transparency and honesty in reporting one’s condition and capabilities is not only ethical but essential in the process of claiming long-term disability benefits.
Ben Glass leads the long-term disability section of BenGlassLaw.
More Information from Long-Term Disability Attorneys at BenGlassLaw
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