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Archive for the ‘Surveillance Info’ Category

While most insureds seem to envision surveillance as a video camera sticking out of a blacked-out van across the street, it’s clear that HUB and other insurance investigators have fine-tuned the art of spying on those who receive disability  benefits. No longer is there a lone-wolf investigator hiding behind neighborhood  bushes, but a very sophisticated, planned operation that views you coming and going.

Most surveillance today is “tag” in nature meaning there are at least two or more investigators strategically positioned at various points in and around your residence and geographical location. There can be two or more cars involved to prevent insureds from noticing the surveillance. Investigators often meet at certain locations and change the cars they are driving to foil the cleverest of insureds from blowing their cover.

It would not be unusual, for example, to have two HUB investigators stationed around your house. When you leave, one HUB guy pursues you and then lets the second vehicle take over. The name of the game is to record insureds, unnoticed, and record as much activity as possible.

Attending a field interview at McDonald’s is very interesting. When you enter the parking lot, take notice of cars backed in. Who backs in their cars at McDonald’s? Only those videotaping out the front window perhaps?

Before the surveillance actually takes place, investigators have already hacked into social media and have a good sense of where you live, what cars you drive, property you own and where you go. Social media hacking isn’t just for disability, in fact, Travelers gets into Facebook pages looking for “hazards and perils” to increase automobile premiums. A picture of an insured getting into a car with a Bud in his hand could cost him more for auto insurance in the long run.

An average three-day surveillance costs from $800 to well over $2,500. I suspect use of the  more sophisticated equipment such as drones and special software is costly and isn’t used in every surveillance investigation. I am still getting word that insurance surveillance, while frequently used, is shopped for the cheapest deals in town.

I am also told that technical equipment commonly used for surveillance can record as much as 500 ft. away. While this article isn’t intended to discuss all of the equipment available for surveillance, it’s astounding to think that you can be seen, and recorded, from 5 football fields away by two or more investigators in several different cars.

Insurance surveillance isn’t nothing. Insurance companies are willing to invest millions of dollars per year in having their insureds spied upon. You can bet it’s profitable.

Like field interview requests, surveillance is an indication there are internal red flags identified that need to be resolved. Although the primary intent of surveillance is to identify “inconsistency of report”, misrepresenting what is actually recorded by translating activities into METS and work capacity goes a long way to assist insurers to deny more and mor claims.

It is summer. Fourth of July festivities are about to begin. The HUB parking lots are empty because they are working diligently to record you exceeding your restrictions and limitations.

If you have a disability claim, please consider that surveillance reflects there is a red flag associated with your claim, and you may be the victim of multiple investigators watching you, and following you at the same time.

Any risks you take in exceeding your R&Ls could result in deniable claims by Labor Day.

 

 

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I received the following comment to the blog this morning. I appreciate the fact that this person took the time to care about others who are private disability victims. Here is the original text. I’ve also included my response.

COMMENT


“I work in a doctor’s office and see the results of this several times a month. It is not worth it. The videotapes aren’t just used to deny claims. Most patients spend years seeking a diagnosis and retaining a knowledgeable physician. It is becoming rare for specialists to even support disability claims or agree to fill out forms and deal with insurers. The insurer uses that and our doctor shortage to their advantage.

In addition to harassing the physician and staff, the skillfully edited tapes are always sent to your doctors. We have even seen them on patients we haven’t seen in years, to get an “opinion” on your reported symptoms. The fastest way to lose a doctor is by not following orders or having their reputation and medical opinions questioned due to your actions. Yes, doctors know you have good days but even selectively edited tapes are powerful. Suddenly, the doctor has questions at the back of his mind and you lose the only local specialist. It will also mean they pass along that information to other doctors who call when you try to retain them. Now without financial resources, there may be no good replacement, let alone one willing to deal with the hassle of a disability claim for a non compliant patient.

The insurer wins by turning your own doctor and your reports against you. Follow your doctor’s orders, honestly report, and assume you are being recorded in public. Finally, PLEASE hire someone like Linda who really knows how to help you.”

MY RESPONSE


Thank you so very much for your comments concerning surveillance and the after math of consequences that takes place. I sometimes wonder whether my readers take me seriously, or believe that many of my posts are reactionary trying to scare people into hiring me.

The truth is, all of the issues I write about on the blog are either provable by documentation, or have been personally reviewed by me, or have been directly communicated to me by credible sources, or sadly, I’ve done it myself as a former claims handler.

I appreciate your comment as I now realize I’ve never discussed what happens to surveillance CDs once they are provided to insurers. What you describe from physicians’ offices is very accurate and probably is the most common reason why physicians “fire” their disability patients. At the time, it may seem pretty benign to romp in the woods at a family picnic by the lake, until you receive a call from your doctor’s office that you need to find someone else to support your disability.

Although a few treating physicians side with their patients and respond, “The surveillance CD does not depict anything other than my treatment plan communicated to my patient and does not change my medical opinion, or medical restrictions”, physicians have a tendency to “act strange”, or “become very conservative” in reporting future R&Ls.

Doctors may not share with you that they have viewed a three-day recent surveillance from your insurance company and that he/she felt a bit of an idiot for recommending total disability. This is the point in time when you begin to notice a change in your doctor’s attitude and facial expressions during visits because in the back of his mind, he is now wondering if you can really work. Remember, “seeing is believing?” That goes for treating physicians as well.

Thanks again for your comment and support. Sometimes I do feel as though people do not always believe me when I write articles or make recommendations. Just yesterday, an insured told me she wanted to wait to hire me so she could “just wait and see what happens.” Sadly, the next thing to happen will be a denied claim when I can do nothing to help her, and her options are limited and costly. Unlike lawyers my focus is to assist insureds to “prevent” denials, not have to deal with them afterwards.

A special thank you to all of my readers and supporters. I couldn’t do this without your interest and continued support!

 

 

 

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Insurance surveillance is a very popular and profitable insurance risk management activity. It is supported by the courts and regulators as a means to investigate claims to verify what is called “consistency of report.” From the perspective of insureds, however, surveillance is regarded as public snooping and invasions of privacy.

The entire purpose of contact surveillance (actually viewing of insureds’ activities) is to verify reported medical restrictions and limitations and ensure a lack of functional physical capacity for work. After all, insureds should not be reporting lumbar chronic pain and fatigue while at the same time putting in 18 holes at the local golf course.

I’ve said many times on this blog that insureds and claimants should never exceed their medical restrictions and limitations for their health’s sake alone. If you do, Murphy’s law will eventually catch up to you and surveillance will prove you can do what you’ve told your insurer you cannot do. Oops.

Although surveillance evidence is clearly not persuasive proof insureds have permanent work capacity to return to full-time work, it doesn’t look good either. An insured previously reported severe pain and incapacity due to multiple failed back surgeries was recorded climbing up ladders to staple colored lights on her house and trees for Christmas. She tried to explain her activity away by saying, “I was having a good day, but suffered for a week afterwards.” Nope….not good enough…her claim was eventually denied with surveillance coverage backing it up.

The old adage, “seeing is believing” applies to insurance surveillance. Visual proof of work capacity is credible, according to insurance sources. And, the insurance industry accepts the fact that, “if you can do it once, you can do it always”, which isn’t necessarily true, of course, but there you are.

In today’s insurance environment, insurers do not always need to “peep” at you from backed out trucks and vans. The Internet, namely Facebook, Twitter, My Space etc. provide excellent means to find insureds talking and talking about their activities. Insurance companies generally investigate three generations looking for activity information. That’s you, your parents and the FB pages of friends and grandparents. Anyone within that spectrum discussing  your family activities can be used to discredit claims. We now know that FB sells your information, the question is who do they sell it to?

LinkedIn is a favorite venue for insurers since the whole purpose of LinkedIn is to be able to “keep your foot in the door” while looking for work. Unum denies claims because of LinkedIn accounts and misrepresents such pages as “your capacity to work, since you’re still looking…..” The Internet global highway should never be used, particularly for social media while receiving disability benefits.

I’m often asked whether surveillance investigators use drones and other sophisticated surveillance devices, and my answer is, “It’s always possible.” However, it’s also important to remember that the use of specialized equipment often costs $800-$2,500 for a three-day surveillance including online investigation. Most insurers now employ entire departments of their own to snoop down Internet information because it’s more cost-effective. Berkshire/Guardian reps check the “FBI’s Most Wanted List” everyday, that’s how paranoid they are.

I have to admit that I see insureds and claimants getting very lax about exceeding medical restrictions and limitations. Just after reporting a “no sitting, standing, walking > 10 minutes restriction”, a young woman asked me, “can I take a trip to Florida to see my folks, It’s several hours ride on a plane.”

“Ugh, no”, I reply, “wouldn’t that be exceeding your medical restrictions and limitations?”

Medical restrictions and limitations mean what they say, by the way, and once reported by physicians to insurers, should be adhered to. I fear insureds often report R&Ls one way, and then act differently in real life – a real risk to future benefits.

Summer is a popular time for insurance surveillance because investigators know insureds are more likely to exceed restrictions. If investigators want to observe you, they can do it; clearly, they have the technology to snoop when you least expect it. If you are using social media in any way, you’re also placing your claim at risk. If using Unum’s website portal, you’re taking another risk. If you have an account on LinkedIn, close it as soon as you can.

If anyone has any questions regarding insurance surveillance please feel free to contact me. The fact that any insurer is conducting surveillance is indicative there are other red flags in your claim that need to be resolved. You may need more assistance than you think.

Needless to say, this is summer, and the insurance snoop dogs are out in full force. With 4th of July just around the corner, you want to make sure you still have a claim by Labor Day!

 

 

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If you ever wanted to know about the adverse affects of surveillance, please read this interesting case submitted by a reader of this blog.
I’ve been advocating for years that insureds not exceed their restrictions and limitations. Now, you can see what could happen if you do. This document contains pictures of the surveillance.

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Insureds are very interested in the possible outcomes of insurance surveillance now that better weather is making it possible to engage in physical activities. Although I’ve written many good articles on insurance surveillance on the Blog, the subject is worth mentioning again with summer just around the corner.

“Surveillance” is an insurance risk management activity that catches insureds in the act of demonstrating work capacity (my definition). Although insureds attribute the most vile and deceptive motives to insurance surveillance, there is no other motive to insurance spying other than this.

Therefore, in order to thoroughly understand why “seeing is believing” is so important to the insurance industry, it is necessary for insureds to accept the concept that “if you can’t work, there should be many other things you also cannot do.”

All definitions of disability require insureds to be unable or limited in the performance of their material and substantial job duties. This means that just having a medical diagnosis is not enough – but “disability” requires a medical condition sufficiently severe to preclude someone from working. Private disability not only requires medical diagnoses, but impairments that physically or mentally prevent the demonstration of work capacity.

It makes sense, then, that insurance companies engage in surveillance because it is possible to visibly record insureds “in the act” of performing physical (and sometimes emotional) activity demonstrating at least sedentary work capacity.

I would be remiss if I didn’t mention that surveillance of social media probably accounts for more denials than peepers through the bushes around your house. The temptation to “spill the beans” about that family reunion on Facebook is too great to avoid, and there are those who risk denials simply by remaining on LinkedIn, a site specifically designed to “hook up” and search for jobs. You may not realize it, but most insurers investigate YOUR activities through at least three generations of “Friends” or relatives on Facebook.

As a claims expert I can only inform you of the dangers of electronic surveillance, and hope that you listen to best advice. Unfortunately, not everyone follows the rules. Use of website portals is encouraged by insurers while at the same time using them is used as demonstrations of work capacity.

Electronic surveillance is a reality in todays “leaking” Google and Internet networks. Cell phones and GPS’ are easy targets to get in to and most investigators will at least know where you are. While most people have done away with their LAN lines, cell phones are easy surveillance investigatory targets for those receiving disability benefits.

So what is “work capacity” then? My definition is: “Work capacity is the ability to perform job description defined work tasks and have the physical endurance to perform those tasks consistently and sustainably.”

Likewise, the definition of behavioral work capacity would be: “The emotional and psychological ability to perform job description work tasks with the capability of maintaining normal anxiety and stress levels reasonable to the occupation performed in a consistent and sustainable way.”

In a nutshell, insureds and claimants often do not realize that medical restrictions reported to insurers are “work” restrictions with possible “crossovers” to everyday life. For example, one physician reported, “moderate to severe fatigue and lack of physical endurance” as a medical restriction, meaning the insured cannot perform his job for these reasons. Therefore, there should never a time when any insurance investigator should be able to record significant physical activity surmounting moderate to severe fatigue.

AND, there is no such thing as, “Well, I have good days and bad days and they caught me on one of my good days.” Forget it – insurers assume, “if you can do it once, you can do it.” Besides, everyone, even healthy people have good days and bad days.

My message here? If you are visibly observed engaging in any physical or mental activity that exceeds reported medical restrictions and limitations, you are presumed to have demonstrated work capacity and the ability to perform actual work. Although private disability may not be denied on the basis of surveillance alone, it is always used to internally bolster an otherwise weak termination of benefits.

While it is true private disability relates to one’s ability to perform his/her own occupation, reported medical restrictions and limitations can also be demonstrated in other ways – mowing lawns, doing laundry, playing golf, going on vacations, taking care of grandchildren and infants, riding bikes…whatever could apply to the unique circumstances of your own claim.

Good weather and summer are nearly upon us; and it is important for all insureds to keep in mind what restrictions have been reported to insurers and make genuine efforts to abide by those restrictions.

You never know when Murphy’s law will catch up with you.

 

 

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Christmas Surveillance?

This is just a reminder that Christmas insurance surveillance teams are likely peeping through your fir trees. It’s at this time of year that some insureds and claimants aren’t where they should be and more active than at any other time of the year.

DCS, Inc. always recommended that insureds never exceed their reported medical restrictions and limitations for their own health’s sake. However, Christmas often seems to take over with a spirit of its own when insureds find themselves walking miles in the Mall, or taking grandchildren to sit on Santa’s lap.

I’ve also always been a firm believer in Murphy’s law since the one time you’ve pushed the envelope was at the Christmas dance-athon when you were recorded on an insurance CD doing your thing with Alvin and the Chipmunks. OK, so that’s silly, but I think you get the picture.

Disability insurers are aware that insureds engage in increased activity during the holidays. Please abide by your medical restrictions and limitations and avoid any issues with surveillance.

I would also like to remind you that insurance surveillance now includes social media, postings and other dialog that takes place on the Internet. I recommend staying off of social media, but if you insist on it, the holidays are NOT the time to show pictures and engage family in your activities.

Insurance companies ARE watching and listening. Don’t become a holiday casualty at your insurer’s banquet table.

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This week I received a call from a woman who was absolutely certain Disability RMS, a local reinsurance company was hacking her emails and forwarding them somewhere else, following her for weeks, and attacking her family and their social media etc.

She was also sure that her Wi-Fi had been tampered with and that every device she owned was now watching, following and hearing what she said. She also concluded that RMS was “messing with her” and was deliberately causing her harm by preventing her from using her Internet.

While I am intensely realistic about surveillance potential today, and sympathize with those who may be the targets of insurance surveillance, it is also very important for insureds and claimants to understand the intent and objectives of surveillance so that this risk management activity can be kept in perspective.

To begin, the type of surveillance described above is cost prohibitive. As everyone should be well aware insurers are all about money, and never spend excessively on claims let’s say under 1M in financial reserve. In fact, non-wealthy ERISA claimants may never experience surveillance solely because of its cost. A three-day surveillance costs from $900-$2,000 per incident.

No insurance company will spend more than what the claim is worth. In addition, surveillance is not conducted when the insurer doesn’t have liability for the claim such as before it is approved for payment, or after a denial. There are exceptions for claim  surveillance during an appeal, but again the financial reserve must be high enough to warrant the added cost.

When I receive phone calls and emails about “excessive surveillance” I often ask myself the question, “To what end?” Disability insurers are interested in visibly catching insureds and claimants performing physical or mental activities in excess of their reported restrictions and limitations. For example, your doctor reported you are unable to bend, stoop, kneel, but the surveillance caught you repairing your roof.

“Insurance surveillance” has to do with, (1) physical or mental functional capacity, and (2) inconsistency of report. That’s it. “Insurance investigation” is for the purpose of discrediting insureds and their applications by obtaining evidence that can be used to destroy credibility.

Notice that none of the objectives for “insurance surveillance” or “insurance investigation” have anything to do with nasty, punitive, deliberate harming of insureds.

There is nothing that can be of benefit to any insurance company from “messing around” with people and causing them harm or inconvenience. In fact, some of the activities insurers are accused of are either against the law, or requires a warrant to do such as tapping telephone lines.

To be clear, insurance companies are interested in denying claims. In order to do that they often engage in surveillance in order to bolster an otherwise weak claim for termination. The purpose of surveillance is to eyeball and record physical activities that are consistent with work capacity, or that are inconsistent with reported restrictions and limitations given by treating physicians.

Insurance investigation is for the purpose of discrediting those who file claims. Once again, the insurance company is looking for “inconsistency of report” and information they can use to allege insureds have work capacity. Insurance companies now have dedicated departments that “snoop dog” the Internet social media looking for information they can use to discredit insureds and claimants who file claims.

What insurance companies do NOT do is spend more money on a claim than it’s worth. Insurers do NOT deliberately “mess around” with you by hacking into your emails, forwarding them somewhere else, nor do they try to destroy your Internet capabilities. Insurance companies are much more subtle than that and just attach tracking software to their website portals that follows you every where you go on the Net.

This year I’ve had reports from insureds that their insurance company continued surveillance for weeks and months at a time. In truth, insurance companies conduct surveillance for three days at a time, usually Thursday, Friday and Saturday.

If the surveillance doesn’t show anything, insurers may repeat 6-12 months later. To my knowledge, insurers never just “sit” on insureds for long periods of time hoping they will eventually be seen demonstrating work capacity that can be used adversely to deny claims.

Again, it’s too expensive to do that. Investigators are never asked to just “sit around” and wait for any particular insured to demonstrate physical capacity. Nor, do insurers hire investigators as covert employees in work out clubs and gyms to spy on people who go to the gym to work out. Disability insurance may be one of the most corrupt industries there is, but it isn’t the CIA and covert 007 tactics are far too expensive to use on any one claim.

It’s very important for insureds to keep insurance investigation and surveillance in perspective. To help you with that, let me suggest that you and your claim isn’t individually all that important. After all, no insurer is going to “make a million” from your claim alone; insurance companies deny thousands of claims each year in order to remain profitable.

If I were an insured or claimant I would be much more concerned with the investigation that takes place online with social media in particular. More insurance “hacking” takes place on social media than by any other means. Still, many insureds choose not to listen to good advice and worry when a denial letter cites information obtained from social media, not only from insureds, but their families, neighbors and friends.

I can understand how insureds might be tempted to let their imaginations get the better of them when it comes to insurance matters. But, in order to have peace of mind, it’s a good idea to keep insurance investigation and surveillance in proper perspective recognizing what it is intended to do, and what it does not do.

And, by the way, insurers don’t care if the idea of surveillance and investigation has you thinking that some James Bond-like character of the CIA is lurking around your bushes hacking into your computer, and. listening to all of your phone calls. The more fearful you are the more likely you will be to do anything the insurance company asks even if it is unreasonable and out-of-contract.

Surveillance investigation is all about WORK CAPACITY, INCONSISTENCY OF REPORT, and CREDIBILITY. Beyond that neither surveillance nor investigation is of any value to denying claims – the true intent and motive of any disability insurer.

 

 

 

 

 

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