Unum Bases Its Decision to Deny Benefits on Surveillance of the Wrong Person
A recent disability insurance case from the Southern District of California, Barbour v. Unum Life Insurance Company of America, 803 F. Supp. 2d 1135 (S.D. Cal. 2011), illustrates yet another way in which insurers sometimes improperly use surveillance to deny or terminate policyholders’ claims. In this instance, Unum (parent company of Paul Revere, Provident, and UnumProvident) actually based its decision to deny a claimant benefits on surveillance footage of the wrong person.
Patricia Barbour was insured under a group disability insurance plan through her job as a school principal. Ms. Barbour filed a claim under her policy due to “severe right quadrant abdominal pain—inflammation small intestines,” for which she had undergone two hernia surgeries, with serious complications. She and her physician explained to Unum that her condition restricted her from driving, walking or standing, and sitting for extended periods of time, and that she was totally disabled from performing hers or any other occupation. Ms. Barbour also reported that she used a cane, and that she needed her mother’s help for her daily activities.
As typically occurs, Ms. Barbour’s claims consultant at Unum retained a private investigator to perform three days of surveillance on Ms. Barbour.
The investigator returned the following report:
A female subject believed to be the insured and hereinafter referred to as such was observed as she departed her believed residence in a 2001 Honda CR–V …, drove to a UPS store and a Vons grocery store, and then returned to the residence. During this time, the insured was observed as she walked around, entered and exited her vehicle … removed a box from [a shopping] cart bent at the waist to place the box in her vehicle, stepped on and off the curb, and raised her arms. The insured moved in a smooth, fluid manner without exhibiting any external signs of impairment or physical restriction. No visible braces, supports or orthopedic devices were observed.
Barbour, 803 F. Supp. 2d at 1139.
Unum denied Ms. Barbour’s claim, based in part based on this surveillance footage. There was only one problem: the footage described above was actually of Ms. Barbour’s mother.
Ms. Barbour challenged the denial of her claim, arguing (among other things) that it was improper for Unum to use the surveillance of her mother as one basis for its denial of her claim. Unum filed for summary judgment, asking the Court to dismiss part of Ms. Barbour’s case without a trial. The Court declined to do so, finding that “a reasonable jury could conclude that [Unum] acted unreasonably in basing the decision to deny benefits in significant part on the 2007 surveillance of the wrong person.” Id. at 1144.
How did Unum base its decision to deny Ms. Barbour’s claim on footage of her mother? It is not as far-fetched as it might seem. First and foremost, claims consultants almost never meet the policyholder whose file they are examining in person, so they have little to no idea of what the claimant actually looks like. Second, private investigators want to provide the insurance company with results—i.e., supposedly incriminating video footage—so that they get hired again. With this in mind, the investigator might not always be fastidious in ensuring they found the right person to videotape. Finally, once a claims consultant has supposedly incriminating video footage in hand, oftentimes the last thing they want to do is examine it for possible errors. After all, they now have evidence they can use to deny a claim (and possibly earn themselves a nice bonus from the company).
How do you ensure this doesn’t happen on your claim? We have written at length before about the ways that insurance companies misuse surveillance to deny and terminate legitimate claims. The best way to avoid the risk of improper surveillance is to have a disability insurance attorney represent you on your claim from the beginning. The attorney can monitor any and all actions taken on your claim, and correct any improper behavior or erroneous information as swiftly and thoroughly as possible.
If you suspect your rights are being violated, strongly consider contacting an attorney who can make sure that surveillance footage isn’t used unlawfully.
