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Archive for the ‘Questionnaires’ Category

I recently had an opportunity to review a Prudential Questionnaire sent to a claimant, and to be honest I couldn’t believe the amount of hogwash the company is asking claimants to provide.

Do you use your computer? What for? Do you shop? What do you buy? Gifts? Do you sleep during the day? How long do you sleep? Do you drive? Where do you go? Do you go out with friends and relatives? How often?

Honestly, the questions go on and on attempting to encourage responses that will automatically give claimants at least sedentary work capacity, and by their own hands too!

Of course, the questions have absolutely nothing to do with material and substantial duties precluding someone from working, but have an awful lot to do with physical activity. I have to admit, though, asking, “Do you read? What do you read?”, is a bit too much for a claimant to take!

The problem here is that I’m sure Prudential claimants believe they MUST answer these types of questions in order to receive benefits. Prudential uses the fear that is already instilled in claimants to invoke controlled responses to questions they never should be asked. Fearful people often respond in ways that are adverse to themselves.

Reading Prudential’s Questionnaire reminds me that the questions are not unlike types of visual surveillance except that responses are coming from claimants themselves – a very clever move on Prudential’s part. It’s always a great deal easier to get claimants to admit they are active enough to go back to work, or, so says Prudential.

I’d like to remind claimants that the only burden of proof they have is what is written in their employer’s Plan concerning the definition of disability. One of my pet peeves is disability insurers who attempt to hold claimants to a higher standard than their Plans do.

Holding claimants accountable to the “objective evidence standard” is a very good example. Prudential’s mental and nervous reviews are infamous for alleging there is no mention of “affect” in the patient notes, or there has been no psychological testing.

Does the Plan document require that? Of course not; Prudential holds claimants to standards that do not exist in the Plan. The only standard claimants need to meet is to prove medically they are incapable of performing their material and substantial duties. Most Plans do not require an “objective evidence standard.”

With respect to Prudential’s Questionnaire, it’s obvious the company has its nose in your lap, and you don’t need to put up with that. You are allowed to diagonal line through specific questions by asking one of your own, “Please explain to me what this has to do with my Plan and the definition of disability.”

Prudential won’t explain it, because it can’t. It obviously draws no distinction between information relative to the Plan and poking their nose into your business to see if you are active enough to go back to work.

Claimants need to pay attention to all Questionnaires that are wolves in sheep’s clothing. You might want to consider responding that if it isn’t pertinent to your Plan you won’t answer questions about your private business.

That is assuming, of course, you aren’t at the same time writing all about it on your Facebook page. Caution is needed here to prevent Prudential from alleging you have work capacity because…..”you said….”

No insurer can hold against you what you do not say or write.

 

 

 

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Disability insurance companies thrive on information. In fact, insurers, assured that everyone who files a claim is dishonest, are paranoid that there is adverse information about you they don’t yet have.

There are only two ways insurers can obtain information about their insureds and claimants. First, they can engage in extensive surveillance and investigation, or they can ask you, or the people you know.

One form of “asking” is to require insureds to complete written “Questionnaires” that are wolves in sheep’s clothing. Unum’s update forms, for example, ask the age-old question, “Describe a typical day.” The truth is, those who are disabled rarely have “typical days” and have difficulty trying to describe patterns of living when they don’t exist.

Unfortunately, most insureds follow human nature (mostly in fear) and attempt to fill up the entire space allotted with information. This is exactly what Unum wants you to do even though it’s exactly the wrong response.

I think it’s fair to say that unless you are working and have unreported earnings, what you do with your day is not relevant to your claim or policy. The tendency of most people is to provide descriptions that include, “I get up in the. morning and have my orange juice, I use the computer, I watch TV, I go for a walk, I do my exercises, sleep for 4 hours etc.”

Some people include information used by insurers for immediate denial, such as, “I babysit my grandchildren, go out to dinner, I’m writing a book, set up for yard sale”, and the like. Some questionnaires are more detailed and want to know if you do laundry, mow lawns, grocery shop, hours spent on the computer etc. Disability insurance companies need to have this information so they can assess your work capacity and send your claim to the denial pile.

In my opinion, disability insurance questionnaires are designed by idiots. Since most activities currently asked about have nothing to do with policy definitions, wouldn’t it be more helpful to insurers to ask questions that DO matter? (Insurance management reading my Blog pay close attention here, you may get a spot award for these ideas!)

For the first 24 months, how about these questions?

  • Based on your last medical consultation with your treating physician what prior job tasks are you still unable to perform?
  • What treatment plan has your doctor discussed with you that includes a return to work in your own occupation?
  • Is your employer holding your job open for your return? Have you discussed a return to work with your employer? Is your employer supportive of return to work?
  • What needs to change in order for you to be able to return to work in your own occupation? (This question IS sometimes included on questionnaires.)

I really hate sometimes to give suggestions to insurance companies, but doesn’t it make more sense to ask questions that will encourage insureds to return to work, rather than trying to get them to admit they walk their dogs and do their laundry?

After 24 months questionnaires could be more relevant to the situation like:

  • Have you contacted SSA to request a copy of its “Red Book” describing return to work programs? Are you aware of SSA’s liberal return to work programs and the fact that you can work part-time while receiving SSDI?
  • Are you medically able to perform some gainful work at home that could earn part-time income and contribute to your financial support?
  • Do you need information concerning SSA’s part-time work criteria?

I think you get the point I’m trying to make. Right now insurance questionnaires aren’t designed to return claimants and insureds to work, but to challenge their credibility with deceptively obtained “snoop dogging.”

It is also true that if insurers where to ask the above suggested questions, they would also need to train their claims handlers to use the information in ways that could help people return to work. Insurers don’t want to take the time, or spend the money to do that.

Currently, insurance forms and questionnaires ask the wrong questions for the wrong reasons. Don’t fall into the trap of “filling up the page with details.” Answer truthfully what you are asked and nothing more.

Still, in my. opinion its lunacy to keep asking insureds whether they do their own laundry, walk the dog, and buy groceries. If only insurance companies were to use their heads and really try to help people perhaps they would have healthier bottom lines.

 

 

 

 

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Consulting helpInsurance questionnaires arrive in the mail on a regular basis. And, most unknowing insureds and claimants will invariably begin to fill up the forms with information about their daily lives that has nothing to do with the definition of disability in any policy or Plan.

Therefore, the question really is, why do insurance companies keep asking about activities such as laundry, gardening, mowing the lawn, computer usage etc. The answer is very simple.

The purpose of insurance questionnaires is to provide written documentation by insureds themselves of work capacity that can be used to deny claims. In many ways, insurance questionnaires also look for “inconsistency of report” describing activities beyond what has been communicated by treating physicians. I’ve read many denial letters that say, “you said in your response to our questionnaire that you use the computer several hours every day…..” Oops…that’s sedentary work capacity, and you just gave away the farm.

Unum often gets very sophisticated about the whole idea of questionnaires, and update forms, looking for information insureds provide. The Hartford and MetLife have multi-page questionnaires that go on page after page asking about every detail of one’s life. One of Unum’s questionnaires asks you to account for your daily activities every 15-30 minutes every day for a week. Talk about over kill!

In the past, Unum’s RNs took each activity insureds put down on the forms and equated it to the number of METs which in turn could be compared to the US Department of Labor’s functional capacity charts for Sedentary, Light, Medium and Heavy capacities for work.

A “MET” is a “metabolic equivalent” of exchanging oxygen when compared to sitting. For example, a person capable of 5 METs can be said to exert five times the metabolic physical energy as compared to just sitting. Five METs is equivalent to sedentary capacity and could be the cause of a claim denial during an any occupation investigation after 24 months.

Do you see how this goes? If you say on a questionnaire that you can carry laundry up and down stairs, the activity is equivalent to 5-10 METs and therefore Unum would say you have the physical functional capacity to perform at least sedentary work. Pushing a lawn mower all summer might also be equivalent to “Light” physical work capacity.

Indeed, insurance questionnaires seem to appear for many different reasons. Unum’s settlement department sends questionnaires out with its lump-sum offers asking what are usually recognized as underwriting questions such as, “Are  you overweight?”, or “Do you smoke?” This is very unusual since the letter and offer made already considered a “mortality value” in the lump-sum amount, so why the perils and hazards questionnaire? If the settlement offer was already made, why the third degree?

It never fails though. I’m asked all the time to review questionnaires that have so much information scribbled into the small spaces it can hardly be read. The tendency is to assume that the more information written in, the safer claims are. In truth, “less is more.”

Here are a few tips on filling out insurance questionnaires:

  • Less is more. Be brief. Answer the question honestly, but only the question being asked, and do not volunteer additional information in an attempt to legitimize the claim.
  • Avoid detail. Again, answer the question honestly and truthfully. “Yes” and “No” are still very good answers to direct questions.
  • You do not have to fill out the entire space provided under each question.
  • You can defer to information already in the file. When asked about restrictions and limitations, defer to your physician who has already provided that information.
  • If you don’t know the answer to something, don’t make up an answer just to fill in the space. It’s OK to say, “I don’t know.”
  • Do  not attempt to speak for other experts such as doctors who have already submitted information to the file. There’s no way you can repeat answers the same way over and over again, so don’t try.
  • Never try to justify or defend a claim in a questionnaire. You don’t have to do that.
  • Do not answer questions about your family, religious activity, sexual, gynecological or dental treatments unless directly related to your claimed disability.
  • Never use the word “retired” or retiring in any questionnaire, written communication or phone call. “Retirement” and “leaving work because of a medical disability” are two different things.
  • Babysitting in particular involves family and unless asked specifically do not volunteer the information – it will be misrepresented as work capacity. The presumption is that if you can babysit your granddaughter on a regular basis, you can work.

The key to filling out insurance questionnaires is to be honest and truthful with direct answers to questions that have nothing to do with your private life. The two most common errors insureds make are, 1) filling in every available space there is on the paper with detail and 2) attempting to justify claims as credible by providing more information than is asked. It is possible to OVERSPEAK OR OVERWRITE a claim into denial.

Don’t fall into the temptation to go crazy on insurance questionnaires. Less is more, and “Yes” and “No” are still perfectly good answers.

 

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Pennywise pound foolishEveryone receiving private disability benefits has at one time received various questionnaires from insurers that at first glance have nothing to do with abilities to do one’s job. Insurance questionnaires tend to ask questions about one’s activities, family, habits, education, and/or ability to perform basic activities. The assumption, of course, is that if insureds and claimants are able to go about one’s life by taking care of themselves, they are able to work.

Then, there are questions about volunteering, watching TV, using the computer…..and again the assumption is that someone who is using the computer all day can work at a job full-time. The most famous of questions is, “Do you do your laundry?”, and, “Do you garden or mow your lawn?”

Smart insureds recognize the difference between being able to engage in activities of daily living, such as traveling to doctor’s appointments and picking up medications from pharmacies, but disability insurers do not. In fact, for some insurers it seems as though any activity at all outside of your bed or home is misrepresented as work capacity.

Today’s focus seems to be whether or not insureds are “taking courses” online or attending courses at various schools. Again, the presumption is that if one has the ability to “think” and “study”, cognitively they can work; also, sitting in a classroom several times a week also indicates (in the opinion of insurers) work capacity.

Insurance questionnaires focus on the idea of equating METS to various activities and then comparing the designation to sedentary, light and medium work capacity. “A MET is a metabolic equivalent of the amount of oxygen consumed while sitting at rest. The MET concept is used by insurers as a simple, practical, and easily understood procedure to expressing the energy cost of physical activities as multiple of the resting metabolic rate.”

To simplify, a MET is a designation that compares energy of various activities to energy expended while sitting. For example, if someone performs 5 METS on a stress test, it means the person is expending 5 times the energy that it takes if this person were sitting. 5 METS, by the way, is equal to sedentary work capacity, at least to disability insurers it is!

Questionnaires ask “private activity” questions to determine energy levels (METS) that can be equated to sedentary, light, medium or heavy work capacity. 10 METS is defined as “light activity” and clearly 18-25 METS would be interpreted as medium or heavy work ability. This is one of two reason why insurers insist on stress test results for cardiac patients (the other is EF, or Ejection Fraction percentages). For example, a cardiac patient performing 5-10 METS with an Ejection Fraction of > than 50% would be presumed to have at least sedentary work capacity, probably more.

Therefore, one can easily see why insurers are so apt to send out “questionnaires” asking about private activities of daily care. Although the questions might appear to be benign, the motivation behind the questions is deceiving. Most insureds first reaction when they get a questionnaire from their insurer is to “fill up the page with information”, because they think, “I’m not doing anything wrong, so my answers can’t hurt me.” This is exactly the kind of misunderstanding about questionnaires that gets insureds in trouble.

To be clear, we always want to make sure information provided in the conduct of any business with an insurance company is provided truthfully, and honestly, but there is no reason why insureds need to volunteer information they are not asked to provide, or information that is not relevant to the definition of disability written in the private disability contract. “Yes”, and “No” are actually pretty good answers to some questions insureds are asked.

“Filling up every questionnaire page” with information is understandable since insureds want to do everything they can to convince the claims rep claims are legitimate. Insureds and claimants tend to think that the more information given, the more credible the claim is considered. Insureds can rest assured that nothing they say or do will actually create credibility, but responding truthfully to only questions asked, and in a very simple way is the best course to follow.

The most typical question usually asked on insurance questionnaires is the infamous, “Describe a typical day” or “describe your daily activities.” The question is actually moot since no one, not even health individuals have “typical” days. Insureds’ first instinct is to begin with, “I get up at 8 a.m. have my orange juice, look at emails on the computer etc……..finishing up (after several pages of explanation) with, “I go to bed at 11 after the news.”

The question itself is misleading since it encourages insureds to describe household activities and activities of daily living that have absolutely nothing to do with medical restrictions and limitations precluding work. In fact, most disabled persons’ day depends on varying levels of pain and fatigue. Healthy individuals also do not do the same things every day because, “I woke up tired today”, or, “Gee, I have a headache.” No one has typical days and it’s foolish to ask insureds to describe one. If you don’t have “typical days” – say so.

Insurance questionnaires are intended to be misleading, encouraging responses that are misrepresented as work capacity. Interestingly, insureds and claimants are NOT required to remain in bed all day with a quilt up to their noses. Those who are disabled still have to take care of themselves and live with impairments; and most daily activities have nothing to do with definitions of disability or medical R&Ls precluding work.

Still, most insurers feel it is obligatory for insureds to “hand off” information about “how they live” and what they do every 15 minutes of their day in order to continue to receive benefits. Imagine what could happen here with phone interviews and being asked questions spontaneously. At least questionnaires are in writing and insureds have time to actually think about their answers.

Don’t allow disability insurers to “punk you” with frequent questionnaires about daily activities. Answer questions honestly; don’t feel obligated to “fill up the form” with volunteered information; use “yes” and “no” answers where appropriate; and keep it brief.

Smarter insureds make it more difficult for private insurers to withhold benefits unfairly. Manage wisely and make it a point to understand how the claims process works.

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QuestionnairesAs all insureds and claimants are aware insurance companies frequently send out “questionnaires” on a regular basis. There are questionnaires about activities, occupations, finances, physician lists, medication lists – you name it, an insurance company probably has a questionnaire asking about it. Some questionnaires are short, while others are as much as 5-10 pages. Unum has a questionnaire which requires claimants to keep track of their activities in 15 minute internals. Even a healthy person would have problems filling that one out.

The question everyone seems to ask about insurance questionnaires is, “What does all this information have to do with the definition of disability contained in my policy?” And, the short answer is: “Nothing at all.”

The purpose of disability questionnaires is to obtain written information from insureds and claimants which can be “interpreted as work capacity.” Since questionnaires are signed by insureds, insurers can always fall back on, “Well, you SAID you use the computer for several hours at a time.” Truth is, I’ve seen it frequently quoted in denial letters, “During your conversation with our field representative you said…..” or, “On the Claimant Statement you wrote you are able to clean house and do laundry.”

Psychologically, most people are more inclined to fill out questionnaires received in the mail than not because it makes us feel good to know someone is “asking for our opinion.” Disability insurance questionnaires take advantage of that fact simply by naming them “questionnaires” and not “insurance interrogatories”, for example. The fact is though that insurance questionnaires are designed to encourage claimants to write as much information as they think will convince any insurance company of the credibility of their claim.

In my role as a consultant I’ve reviewed perhaps thousands of insurance questionnaires completed by insureds to the point that you couldn’t possibly get another word on the page. Every waking moment and activity is described in detail – an insurance company’s dream denial waiting to happen! Insurance questionnaires are deliberately designed with questions which when viewed as a whole signal at a minimum, sedentary work capacity. The result is insureds and claimants give away their disability claims with too much information that can be interpreted and used against them.

For example, at one time Unum devised a program which used basic information about gardening, laundry, and computer use, to equate activities to actual numbers of METS which then could be cited as work capacity. A MET is the metabolic rate of expended energy (or calorie burn) of a human body at rest. Sitting in a chair is 1 MET. Therefore, if Unum concluded carrying laundry up and down stairs 3 times a week is equal to 5 METS (or 5 times the energy expended at rest), then it could be said the individual has sedentary work capacity because 5 METS is often defined in that way. Ten METS would be light work capacity and so on.

Unum also determined that having sex more than three times per week was also indicative of work capacity. (5 METS) This is why phone interviews include questions about sexual activity. Are you kidding me?

Therefore, a unknowing insured completing a questionnaire with activities of laundry, gardening, cooking, hobbies, walking, exercising, could actually be citing 5 or more METS of activity without really thinking about it. Again, what does all this have to do with your inability to perform the major tasks of an occupation full-time? Absolutely nothing.

Being able to walk your dog up and down the street is NOT the same thing as having the ability to return to work on a consistent or sustainable basis, although the insurance company will allege that’s true. If insurers used the information reported on questionnaires in a fair and reasonable manner, considering reasonable expectations of work capacity, questionnaires could be considered rather benign to the process. But, insurers DO NOT use reported activity information reasonably, and as a result claims are denied simply because insureds wrote on a questionnaire “I do my laundry”, and “walk my dog.”

Insurance companies are absolutely paranoid about unreported work capacity, and frequently cross the contractual line of asking questions unrelated to your ability to perform the material and substantial duties of your own or any other occupation. Imagine this example: Liberty Mutual forces claimants to apply for SSDI with eligibility requirements of total disability. Claimant applies and is approved; a overpayment is given back; and a questionnaire is sent out. Claimant writes she is able to cook and do her laundry several times a week, and her internet surveillance indicates she chats and tweets at least several hours a day. Claim is denied because she has demonstrated sedentary capacity, and at the change in definition after 24 months, alternative occs are identified. End of story.

Insurance companies rarely do anything without an agenda to deny claims. Questionnaires are designed to encourage “over speaking” one’s claim to the point of giving away the farm. Although the questionnaires themselves ask for narrative responses, answers need not be paragraphs, but one liners. Although DCS, Inc. recommends that all information given to insurers be truthful and accurate, it need not exceed what is required as “proof of claim” in a policy contract.

Questionnaires are also designed to use responses in conjunction with surveillance to prove “inconsistency of report.” If you document you are unable to walk greater than 10-15 minutes on a questionnaire, but surveillance indicates you walked around the Mall for half a day, the result is “inconsistency of report.” In other words, your “observed” activity is greater than what you are willing to admit to on a questionnaire. Not good.

Another thing to also remember is that insurance questionnaires, phone interviews and field rep visits are all used and conducted for the same reason. This should make any insured or claimant sit up and pay attention to what he/she writes or says to any insurance company. Giving truthful answers is not exactly the same thing as answering only what has been asked and no more. This situation reminds me of the difference between Tax Avoidance and Tax Evasion. Insureds and claimants may not deliberately give false information, but they certainly are permitted to provide information about their activities on a “need to know basis.”

Disability insurers are entitled to medical and occupational information because it directly relates to the definition of disability in most policies. They do NOT have a need to know your hobbies, your social activities (unless you give it away on the Internet), your religion, or sexual preference.

Not all things are as they seem with disability insurers looking to deny claims rather than pay them. Questionnaires are indeed wolves in sheep’s clothing and should be taken very seriously by insureds who are asked to complete them. Again, responses must be honest, but then again, you don’t have to contribute your entire life’s story.

Responses should be no more than one or two short sentences; don’t elaborate; don’t volunteer information not asked; and most importantly, don’t attempt to describe restrictions and limitations which after all should only come from physicians. Further, don’t attempt to “make-up” something just to have an answer on the page; if the question doesn’t apply to you say so. You don’t have to “fill up” the questionnaire in order for it to appear credible.

This wouldn’t be a fair post if I neglected to mention that some claimants do have a tendency to overstate their disabilities and understate what they can and cannot do. I have discussions with my clients about the fact that “honesty works”, and it is never a good idea to deliberately understate activity capability for the purpose of misleading the insurance company. To do so is actually insurance fraud, and of course, I don’t support that.

But, what I also know is that insurers use their questionnaires to obtain information about activities in very covert ways. What could be more innocent than a questionnaire, right? Readers should consider responses on insurance questionnaires very carefully and then give short, honest answers.

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