Since many insureds and claimants are asking questions about insurance field visits I thought perhaps a dedicated Q & A might be appropriate. These are questions I typically get by email nearly every day. I hope the information in this post helps add to other posts located on Lindanee’s Blog.
I’ve been contacted by Unum to do a field visit. Do I have to do it?
This is by far the number one question concerning field visits. Yes, you must meet with a field representative if your policy says you have to. However, the majority of those asked to do field interviews have not read their policies, if in fact they have copies. I estimate that 70% of the people who ask me this question have NOT obtained copies of their policies and certainly haven’t read them. The definition describing the duties between parties to a contract are contained within the contract document itself.
Usually, there is provisional language located after the IME wording, “we may also ask you to be interviewed by a field representative…” If your policy does not contain such language, you do not have a contractual obligation or duty to comply with the request. Insurers such as Unum “forget to mention” that for some, field visits are voluntary and not duties under the policy contract.
Most attorneys take a very liberal attitude toward field visits and recommend insureds “do it anyway.” This is probably because it isn’t advantageous to them financially to enforce the policy contract. But, make no mistake. Field visits are up close, in-your-face personal profiling conducted with the intent of obtaining inconsistent information, or facts which can be used to render denial decisions. These visits aren’t conducted, as Unum often says, “to get to know you better.” Field visits are indications the insurance company is “risk managing” your claim and are never good news. If you don’t have the contractual duty to submit, why do it? Check your policy first, and then respond accordingly.
Unum’s G4S representative came right up to my door and kept knocking without notice. What do I do now?
All insureds and claimants should have a small “No Trespassing” sign on their lawn. Years ago DCS, Inc. coined the phrase “private trespass.” With the advent of professional private investigators retained by insurers, tactics can often be invasive and violate personal property and privacy rights. Insureds are not required to speak with any insurance PIs who shows up unexpectedly at the door; and they should never be permitted to enter into homes. Insureds can insist on at least a 30-day notice scheduled at a location and time of their convenience. Scheduling should take place through the claims specialist, not the G4S rep who continually calls on the phone.
In addition, insurance PIs are NOT decision-makers on claims and have no authority to demand information from you. Notify the claims handler that the G4S or The Hub investigator invaded your privacy and that you will schedule a meeting at a later date at your convenience and location. Never meet with a field rep in the home.
I want to record the field interview. Can I do that?
Yes. In fact, the field rep may also record the interview at the same time. However, please note, insureds are under no obligation to provide Unum or any other insurance company with a copy of YOUR recording. If the field rep requests a copy, he/she is free to record the session at the same time you are.
Will G4S conduct surveillance at the same time as the field visit?
Probably. There is a good chance G4S will conduct surveillance the day before, the day of, and the day after the interview. Again, this is an attempt to discover “inconsistency of report” with the information you provided at the interview. For example, at the interview you said you couldn’t lift more than 5 pounds, but the day after were observed lifting and carrying a 40 pound grandchild around the mall. Or, previously you told the claims handler that due to carpal tunnel you couldn’t use your left hand to push or pull anything. On the day of the interview cameras caught you winging open the heavy door to McDonald’s with your left hand.
Before entering McDonald’s or Wendy’s for the actual interview, claimants should take a closer look at the parking lot to see if any of the cars are “backed in.” Who backs in a car at McDonald’s? Also, insureds should choose a booth not visible through windows; closer attention should also be paid to burly people eating their Big Macs around you.
What sort of questions will they ask?
Let me be clear here: field interviews are planned interrogations. At first, questions are designed to appear credible and straight forward such as, “Who are your physicians?”, “What are your medications?”, and When were you last treated?” There is always an attempt to gain your trust and establish a rapport so that you will feel comfortable answering. Many reps use the old, “I’m just like you”, ploy to encourage trust and a feeling you can share. This is where claimants with attitudes of, “I don’t have anything to hide” go astray and begin a hour-long discussion disclosing every personal and medical aspect of their lives for the last several years. Oops…gotcha!
The next set of questions have to do with your activities, hobbies, interests, religion, sexual activity, etc. Once you feel absolutely comfortable with the field rep, a new set of questions is asked which reveal your functional capacity such as lifting, carrying, bending stooping, ability to type, use the computer etc. It is likely the investigator already knows you’re on the computer in chat rooms, FB etc. for several hours at a time so it doesn’t do any good to say you only use the computer to check emails. It’s OK to ask the question, “What does this have to do with the definition of disability in my policy?” Or, “Is there a question in there somewhere?”
Finally, questions concerning work ability and other income are generally asked. Claimants are recommended to answer questions truthfully and honestly, but not to volunteer information that is NOT asked. Over-speaking during a field interview should be avoided. Field visits should only take 30-45 minutes and insureds have the right to say, “I’m sorry, I’m not feeling well, and need to draw this to a close.” Interviews should never be allowed to go beyond 30 minutes because it could be said you were able to sit for that long, were able to answer, and therefore have work capacity. Remember, field interviews are personal profiling.
A final word here…….there are questions which insurance field reps do not have the right to ask. Questions about religious worship, attending church, or practices of certain religions are off-limits as are questions about sexual preference, domestic partners, sexual practices, fertility treatments, birth control, and specific questions related to HIV/AIDS or employment performance. In addition, claimants are not required to answer any other questions they don’t know answers to, or feel uncomfortable with.
What should I wear to the interview?
Dress comfortably, but neatly. It is not necessary to “dress-up” for the occasion, but only that you are comfortable and neatly presenting.
What if the interviewer begins to abuse me, or becomes rude and hostile?
Insureds and claimants always have the right to stop the interview at any time and shouldn’t feel obligated to put-up with rudeness, hostility and argument. Insureds can simply say they are drawing the interview to a close and will contact their claims handler. It’s OK to leave when the insurance rep is too aggressive or overbearing. Remember, you have been recording the session and can prove the reps behavior if asked to.
What authority does a field rep have over my claim?
None. A PI field rep is a personal profiler and writes a report about how you looked, acted, were dressed, and answered questions. He/she has no right to demand you sign anything, or provide information to him at the interview. If and APS is asked for, provide it to the claims specialist, not the field rep – you want to make absolutely sure all information gets into your file. If the interviewer asks you to sign an Authorization, also provide it to the claims handler.
Field reps have no authority over your claim or the ultimate decisions made, but their reports ARE relied upon to challenge claims and are used as evidence of self-reported work capacity. Claimants might keep that in mind when speaking with them.