What Investigative Tools Do Insurance Companies Use When Assessing Disability Claims?
Investigative Tools Used By Insurance Companies
There are several investigative tools used by insurers when assessing disability claims which include;
- Independent Medical Examinations (IME)-described above
- Functional Capacity Evaluations (FCE)
- Referrals to medical consultants
- Home visits
- Social Media
Functional Capacity Evaluation (FCE)
- Unlike an IME, an FCE is not contractually required and is not usually a medical examination
- It is a collection of tests used by the insurer to test a claimant’s maximal physical effort
- The information from the FCE is then used by the insurance company to make inferences with respect to whether or not an individual can work full-time on a sustained basis
- There may be legitimate grounds upon which to refuse to attend an FCE, and claimants should be vigilant about asserting rights to refuse such testing
- Insurers often use in-house medical consultants to contact a claimant’s treating physician to discuss the claimant’s condition, restrictions and limitations. In essence, the insurer’s medical staff seeks to develop evidence from the physician to demonstrate that the claimant is not disabled. Often, the insurer sends a letter to the physician “confirming” the conversation and requesting a signed acknowledgment from the treating physician that he or she agrees with the statements in the letter. The letter, however, may either distort the facts, or cast the claimant in an unfavorable light.
- A claimant should instruct a treating physician to not respond to such a letter without first reviewing the contents of the letter with them in detail.
- Insurers also utilize medical consultants to review claims, relying upon a non-examining physician to address functional abilities. This has inherent problems, because it precludes the claimant from receiving an appropriate evaluation of the claim. It is vitally important, therefore, that claimants ensure that their treating physicians provide well-developed, organized office notes and/or narrative reports to support the claim.
- Home visits are common techniques employed by insurers when assessing disability claims. An insurance company representative, often identified as a rehabilitation consultant, will stop by either unannounced or at a prearranged time to speak to the claimant. This individual will seek to ascertain the claimant’s activity level, determine whether the claimant is working on another interest, or to develop other information to be used by the insurer.
- Caution should always be used when speaking to the insurer or its representative. Such interviews should be done on the claimant’s terms, whether recorded with witnesses or by having a confirmation of interview prepared, all to avoid anyone distorting the information provided.
- Surveillance is another technique frequently used in high-benefit cases, or where claimants allege disability based upon either subjective type conditions or where the objective support is not indicative of the restrictions or limitations.
- In high benefit claims, the insurer is willing to invest significant money to terminate or deny a potentially expensive claim. Claimants must be wary not only of their activity levels while on claim, but of any statements made to the insurer about their daily activities. Inconsistencies can be fatal to a claim: the expression “a picture is worth a thousand words” holds very true with regard to surveillance.
- Insurance companies can view your social media page as part of their surveillance techniques.
- If you have profiles on social media (such as Facebook, Twitter, MySpace, Instagram or other social networks) and are involved in litigation, be forewarned that insurance companies use the Internet as part of their research.
- Think before you post!
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