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Archive for the ‘Surveillance Info’ Category

This is just a reminder that summer surveillance is in full swing. Several people have contacted me asking for advice when they noticed cars following them, or sitting across the street.

While I have always advised clients and non-clients not to exceed their reported restrictions and limitations,  not everyone listens to good advice.

Some one recently told me, “Yes, I had to go to my family outing at the lake but I suffered for a week afterward.” I wouldn’t count on this excuse getting you out of a denied claim by Labor Day. The “good days and bad days” just doesn’t cut it anymore with most insurers.

The best course is not to exceed your reported medical restrictions and limitations and be aware of what’s happening around you.

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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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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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