Insurance companies are for-profit institutions, and as such, have an interest in not paying your claim. They know that it is not unheard of for employees to file for disability and exaggerate their symptoms in order to maximize their payout. In an effort to determine if a claim is valid, insurance companies will often utilize surveillance in determining the legitimacy of a disability claim.
How Surveillance in a Disability Claim Works
Texas employers that offer long-term disability insurance will be governed by ERISA law if the coverage is provided through a group plan. Insurers can refuse to pay a claim, and one of the reasons for these refusals is that the applicant is faking or exaggerating their injuries.
As a result, the insurer may engage in surveillance tactics to prove that your injuries are not as you claim.
This can be done through:
Physical surveillance is when an investigator is hired and will follow you around. This individual is looking to prove that your case is invalid. For example, if you suffered an injury to your leg and said that you can no longer squat down to pick up packages at work, the individual will look for instances of you squatting down to pick up your child or packages off your doorstep. The investigator cannot legally go onto your property, but they can be at the same ballgame as you or watch what you’re doing in your backyard.
Electronic surveillance is growing in popularity thanks to people putting their entire lives on social media. These investigators will look to see if you’ve posted pictures or videos performing activities that you could not have done given the injury or symptoms listed on your disability claim.
Finally, the insurer can send someone to your home to conduct what is known as a “field visit.” These visits are often framed as the person following up and trying to learn more about your case. But when they enter the home, they’ll be scanning the home for anything amiss.
Perhaps in your claim, you mentioned that you cannot do your own house cleaning, so if your home is tidy and you have cleaning supplies out on the table, the insurer may question your symptoms.
Insurers will look for any reason not to accept your claim, even if it’s minor or outlandish. Perhaps you cannot pick up the 50-pound boxes at work that you have to as a mover, but you can pick up an envelope that fell on the floor. Even picking up the envelope may be enough to question your claim.
Of course, you have a right to fight back against claim denials, especially if your case is legitimate.
What Insurers May Also Do to Disprove a Claim
Basic surveillance is a given, but an insurer can go even further in an effort to disprove a claim. The insurer may also:
- Interview your neighbors to determine if they’ve seen you doing anything that can be used to deny your claim.
- Take video or pictures from outside of the home to use as proof against you.
- Follow you in their vehicles.
It’s not uncommon for a claimant to feel like their privacy has been violated and that they must act or behave a certain way. You should not stop your normal routine to prove your case. Instead, you should continue performing your normal activities so long as you’re following your doctor’s advice.
If your doctor advised you that you could go for a light jog, don’t let the surveillance on a disability claim stop you.
Honesty is the best policy when filing a claim, and if you’ve been truthful about your limitations, symptoms, and injury, you really have nothing to hide.
Tips for Dealing with Surveillance
You need to deal with your claim while also living your life. It’s important to do a few things that will allow you to live a life of normalcy without jeopardizing your claim:
- Don’t push yourself. You should not be performing any activities that your doctor has warned you against. It’s important to take it slow and set limitations. Not only can an investigator use your actions against you, but if you don’t continue in your limitations, you risk aggravating your condition and making it worse.
- Stay off social media. If you have a disability claim pending, be sure to stay off of social media. You may post an innocent picture, even from weeks before your injury, and this may be used against you. Also, ask your friends and family to stop sending updates about you or posting pictures.
- Contact a lawyer. Working with a lawyer in Texas that specializes in ERISA disability claims can help you make sense of the surveillance and work towards a claim approval. A lawyer will ensure that the insurance company is acting within their rights and not engaging in any activity that may be illegal and violate your rights.
Surveillance plays a major role in your disability claim. If you notice that the insurer has hired a private investigator, contact a lawyer and be sure to follow your doctor’s instructions rather than push your limits.
Reach out right away for a no-obligation consultation to discuss your disability claim.