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Field Interviews: What to Expect After the Interview Ends

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We’ve discussed why an insurer might want to schedule a field interview and what to expect before and during the interview itself.  Now we review what claimants can expect can expect after the interview ends.  Again, the process is usually different depending on whether not a disability insurance attorney is involved.

After the Field Interview

After your interview ends, the field representative will leave to do some additional reconnaissance.  Without telling you, the representative may drive to your office to talk to people on your staff.  He or she will see what the office looks like, if it’s busy, and whether your name is still listed on the door.  If you have an attorney, the attorney will have discussed this with you ahead of time, and together you will have taken steps to make sure the representative doesn’t bother your staff or catch them off guard.

Some days after the field interview, the representative will send you a copy of his or her report, which purports to summarize your conversation.  The report will ordinarily be 8 to 10 pages or more.  He or she will ask you to review the report, make any changes you see fit, and return it.  The representative will advise that if you don’t make any changes by a certain date, he or she will assume that everything in the report is accurate.

For claimants with legal representation, the report will be sent to your attorney’s office. Your attorney will review the report to make sure that it accurately reflects the facts of your claim.  He or she should be able to correct any seemingly harmless statements that a claims adjuster may take out of context to support denying or terminating your claim.  If any important information is missing, your attorney will make sure to include it along with the report.

Meanwhile, the field representative will usually send a separate report to the insurance company.  This second report will have the representative’s personal observations about you, their conversations with your staff, and any other information he or she was able to gather about your outside of the interview.  You will not be provided with a copy of this report unless you’re able to obtain the claim file after your claim has been terminated or denied.  If you have an attorney, this second report will be much more limited, as the representative will not have had the opportunity to visit your home or to pry into irrelevant or confidential information.  If your claim is denied or terminated, your attorney will obtain and review this report for any inaccuracies or misstatements.

A field interview can be intimidating, but knowing why the interview is being conducted and what to expect during the process can make you better prepared to handle it in a way that doesn’t prejudice your claim.  If you have questions or concerns about a field visit, contact a disability insurance lawyer right away.

Field Interviews: What to Expect Before and During the Interview

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Our last post discussed why an insurance company might want to conduct a field visit or field interview.  Now that you know what the insurer is trying to accomplish, we’ll discuss what exactly to expect before the interview, during the interview, and afterwards.  As with many aspects of the claims process, the field interview will be different depending on whether or not you have a disability insurance attorney involved.  First, what to expect before and during the interview:

Setting Up the Field Interview

Initially, the field representative will call or e-mail you personally to set up a time to meet.  He or she will ask to come to your home, or sometimes your office (particularly if you have been practicing as a dentist or physician), and talk one-on-one. If you’re being represented by a disability insurance lawyer, the field representative will call or write a letter to the lawyer’s office to request a field interview.  Your attorney will evaluate whether the in-person interview is necessary and appropriate under the terms of your policy and your particular claim situation.  If so, your attorney will likely ask the field interviewer to meet at the attorney’s office, rather than in your home or office.  Your attorney, and sometimes an assistant as well, will attend the interview.  The attorney and/or his or her assistant will take careful notes of the entire conversation.

During the Field Interview

When the representative arrives, he or she may ask to take your photograph.  The representative may also ask to audio-record your conversation.  If an attorney is present, the representative will usually refrain from asking to take a photograph or audio-record the conversation, knowing that your legal counsel will likely determine it unnecessary and/or inappropriate.

The field representative will sit down and talk with you for an hour or more.  He or she will have an extensive list of questions to ask you, most of which your claims analyst will have specifically requested the representative address. For those with legal representation, your attorney will have prepared you for each of the questions the representative will ask, so you’ll be ready to give accurate and well-considered answers.

During your conversation, the representative will be very warm and friendly.  The representative will normally try to establish a rapport so that you’ll relax and talk openly.  He or she will try to get you to talk without thinking, encourage you to go into unnecessary detail, and may ask personal questions that a claims adjuster would normally avoid.

The representative often acts somewhat more reserved when an attorney is present.  Field representatives know that if they ask any questions that are irrelevant, seek confidential information, or are otherwise inappropriate, your attorney will intervene and let you and the representative know that you don’t need to answer the question.

While you’re talking, the field interviewer will take copious notes.  These notes will include the interviewer’s own observations about your appearance, how well you move, how long you were able to sit or stand, what your house looks like (if in your home), and whether you seem nervous or not.  If your attorney attends, the representative will know that his or her notes will be compared against the attorney’s, so he or she will be especially careful to document the circumstances accurately.

In our next post, we’ll talk about what happens after the field interview ends.

Why Does My Insurer Want to Conduct a Field Interview?

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At some point after you’ve filed a disability insurance claim, your carrier may contact you to arrange a “field interview.”  Also called a “field visit,” a field interview is when a disability insurer hires a representative to come meet with you face-to-face to talk about your benefit claim.  Most times, the company will ask that you meet the field representative at your own home or office.

Your claims analyst will probably tell you that the field interview is just a way to get to know you better, or to help the company gain a better understanding of your claim.  What the claims analyst won’t tell you are the real reasons why insurance companies put so much time and effort into planning in-person field interviews, such as:

  • To take your picture so that a private investigator will recognize you during surveillance.
  • To find out what your house and/or office looks like to further aid in surveillance.
  • To look inside your house and see if you’ve been doing a lot of housework, paperwork, cooking for yourself, etc., all of which (according to the insurance company) can mean you’re able to work in your own occupation.
  • To see if you look like you’re in pain, if you can sit down for a long period of time, or if you can walk without any gait abnormalities.
  • To see if you look like you might have current monthly income from sources other than your occupation (i.e., if you have a nice car, a big house, a boat, etc.).
  • To drop in and try to interview your spouse, former business partners, office manager, or neighbors.
  • To try and get you to relax and open up, or to catch you off guard so that you give information the company can use against you.

In our next post, we’ll discuss what you can expect during the field interview itself.

Why Won’t My Doctor Help With My Disability Insurance Claim?

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We frequently discuss how important it is for your treating doctor to support your disability insurance claim.  Oftentimes, though, doctors are reluctant to help with the process.  Understanding why your provider is hesitant to get involved can better equip you to enlist his or her support.

In our experience, these are the most common reasons why treatment providers decline to assist with disability insurance claims:

They don’t have time.  Doctors have extremely busy schedules.  Often, they’re concerned that they simply don’t have enough time to properly complete all of the insurance company’s required forms or to answer questions from your claims adjuster.

They are worried about the insurance company harassing them.  Many healthcare providers know how complex and combative disability insurance claims can be.  Sometimes, providers don’t want to get involved with a claim at all, because they’ve heard of (or experienced) claims personnel harassing treating doctors.  This can be a legitimate concern, as left unchecked, insurance companies will often bother treating doctors with repetitive requests for information, pushy phone calls, or by second-guessing the doctors’ treatment plan.

They are worried about doing something to hurt your claim.  On the other hand, many providers aren’t familiar with the private disability insurance claims process at all.  This sometimes makes providers hesitant to complete Attending Physician’s Statements or to discuss your claim with an adjuster for fear that they will inadvertently say something that prejudices you.

They don’t know the definition of disability in your policy.  Not every treatment provider is familiar with the type of own-occupation policy that many physicians, dentists, and other professionals purchase.  When some providers hear the word “disability,” they think of a state of total helplessness, or of the much more stringent Social Security definition of “disability.”  If a provider doesn’t know that your policy deems you “disabled” if your condition prevents you from performing the duties of your own job, he or she might think you don’t qualify for benefits.

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Understanding Residual Disability Benefits: Are They Worth The Cost? Part 3 – Current Monthly Income

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In our previous posts, we identified the basic formula disability insurers use to calculate residual (partial) disability benefits and discussed variations in how disability insurers calculate Prior Monthly Income.  Now, we will examine the other principal component in calculating a residual disability benefit: Current Monthly Income.

Current Monthly Income is the calculation of how much a doctor is earning now, versus how much he was earning prior to his disability.  Although this sounds like a simple concept, calculating Current Monthly Income can be challenging in the healthcare industry.  Many physicians and dentists own their own practices or are a partner in a practice group.  Their income is not only based on their productivity, but also includes a passive component from the other business activities of the practice.  For example, a dentist may employ one or more hygienists or associate dentists who generate additional revenue.  When a doctor becomes disabled, the practice revenue may remain relatively constant as associates increase their production to account for the doctor’s reduced schedule.

Some insurers take advantage of this by calculating Current Monthly Income not on the doctor’s production, but rather on the practice’s revenue.  This fails to take into account the true financial impact of a disability because, while revenue may remain high, expenses increase as associate doctors and hygienists work more (and earn more) to fill in for the disabled doctor.

Additionally, many doctors pay themselves based on a percentage of their own production, in addition to the income they earn as practice owners.  When a doctor becomes partially disabled, his income from working in the practice will drop, even if the practice’s overall profitability does not.  Depending on the language in a particular policy, the policy may not take into account the drop in production, and the doctor may not be able to recover the full loss caused by his disability.

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Electronic Medical Records: What You Don’t Tell Your Doctor Might Hurt Your Disability Claim

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Over the last ten years, there has been an increasing movement away from paper records and toward Electronic Medical Records (EMR).  This move has been accelerated by the federal government’s mandate that doctors who treat Medicare and Medicaid patients must have adopted and implemented EMR systems as of January 1, 2014.

There are many benefits to using EMR.  They can facilitate patient care between referring doctors, improve data tracking over time, increase efficiency and reduce errors.  However, EMR systems have drawbacks when they are used for purposes never intended, such as to document a disability claim.

Many EMR systems allow the doctor to input his findings for every major system in the human body, such as the cardiovascular, musculoskeletal, gastrointestinal, neurological and psychiatric systems.  However, if the doctor does not put in something regarding one of the symptoms, the default setting on the EMR will report the system as being “within normal limits” or that the patient has “no complaints.”  The concern with this from a disability perspective occurs when a patient sees his doctor for a condition unrelated to his disability.

For example, a patient with a history of degenerative disc disease could visit his doctor for an unrelated infection or illness.  Since the doctor is conducting only a limited examination for purposes of treating the presenting illness, he may not input any information related to the patient’s disabling condition.  The EMR will then generate an inaccurate record stating that the patient’s musculoskeletal system and neurological system are within normal limits.

Disability insurance carriers can then use these default settings to their own advantage to raise questions about the severity of the claimed disability, justify an independent medical examination or functional capacity evaluation, or support a claim termination.  For patients who are receiving disability benefits, it is therefore important to know what their medical records look like and to effectively communicate with their physicians to ensure that their conditions and symptoms are accurately recorded on each visit.

Beware the “Offset”

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Insureds may think that if their claim is approved and the insurer begins paying benefits, they have won the battle. In reality, however, even the insurer’s complete admission that the insured is disabled within the terms of the policy does not mean that the insurer will pay the full monthly benefit listed in the policy. Most of us think of disability insurance as providing a stream of income to replace lost salary, but few understand that these policies often contain language effectively cutting off other benefits to which the insured would otherwise be entitled.

Disability insurance policies, especially long-term disability policies, frequently contain “offset” provisions, which offset other benefits against the insurer’s monthly payments. Common offsets include benefits which the insured receives from Social Security disability or retirement, unemployment compensation, worker’s compensation, no-fault auto insurance, sick leave, severance pay, and others. The net effect of these offsets is that should the insured receive a benefit from another source, the disability insurance company will reduce its monthly payment by the same amount.

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How Can I Keep My Disability Insurance Company From Contacting My Doctors Without My Consent?

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In our recent post, “Should Disability Insurance Companies Be Deciding What Kind of Care You Receive?” we explained that insurance companies will often contact your treatment providers directly without your consent, ambushing them with medical studies and demanding answers to a plethora of questions about your medical treatment in an effort to undermine your disability claim.  In many instances, insurance companies will refuse to produce the medical reports their in-house doctors wrote about you, but still expect full access to your treatment providers and their reports.

If this happens to you, you may (justifiably) feel like the insurance company is going behind your back and unfairly manipulating the claims process.  Your treatment providers may become upset because the insurance company is harassing them to respond to detailed questions without adequate time to understand the questions and/or provide thorough answers.  You may even notice your doctors acting differently towards you after speaking with the insurance company.  For example, your doctor might begin to avoid you when you ask him or her to provide you with documentation to support your claim.

How can you protect your treatment providers from being ambushed by insurance companies and protect your claim from being manipulated?

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How Functional Capacity Evaluations Impact Your Disability Insurance Claim

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Our last post discussed what to expect during a functional capacity evaluation (“FCE”), as well as the intended purpose of an FCE.  Though FCEs can be a useful tool for measuring your abilities, FCEs do not always provide results that are truly indicative of your ability to do your job on a regular, consistent basis.  Many courts have recognized the weaknesses and limitations of FCEs in the disability insurance claim context.

Weaknesses and Limitations of FCEs

There are approximately 10 different types of FCEs, each with its own program, measurement methods, and possible evaluative outcomes.  Because FCEs can be influenced by many factors, such as physical ability, beliefs, and perceptions, FCEs need to “be interpreted within the subject’s broad personal and environmental context.”[1] Thus, the FCE “process and its administration are only as good as the examiner.”[2]

Disability insurers often stop paying benefits based on FCE results, even when you can’t actually meet the demands of your former job duties on a consistent basis.  This is due to an inherent limitation of FCE testing: the FCE can only measure your capacity to do a certain task for a limited amount of time on a certain day.  For instance, you may be able to push and pull ten pounds for a few minutes during the FCE, but that doesn’t mean you can do the same task all day, every day.

Another important limitation of FCE testing is how effort is measured.  The FCE examiner normally monitors the subject’s heart rate to determine if he or she is putting forth full effort.  If your heart rate isn’t high enough, the examiner will say you didn’t try your hardest, so you can probably do more than you demonstrated during the testing.  However, there are factors that affect your effort level that can’t be measured by your heart rate alone. For example, heart rate monitoring doesn’t measure the impact of migraine headaches, kidney failure, or other non-exertional limitations (such as interference with attention and concentration due to pain and fatigue).

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What Is a Functional Capacity Evaluation?

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After filing a disability insurance claim, your insurance company may ask you to undergo a Functional Capacity Evaluation, or FCE.  The insurer tells you where and when to show up, but you likely have little idea what to expect when you arrive.  What is an FCE, what is its purpose, and how will it affect your claim?

What Is an FCE?

FCEs are formal examinations performed by occupational therapists (OTs) or physical therapists (PTs), not physicians.  The purpose of the FCE, according to your insurer, is to evaluate your ability to perform the substantial and material duties of your occupation.

What Can You Expect at the FCE?

FCEs usually last between four to six hours, but depending on the tests your insurer has requested, they could be longer, taking place over two consecutive days.

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