Posts Tagged ‘Insurance Questionnaires’

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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