Insurance Bad Faith: Private Investigators and Their Surveillance Practices
Insurance companies often will hire a private investigator to aid in terminating disability insurance claims. Ostensibly, the purpose of a private investigator is to expose dishonest individuals of fraudulent disability insurance claims. A private investigator may even advertise as a “Disability Insurance Fraud Specialist.” All too often, however, insurance companies and their investigators are not seeking to expose fraud, but to manufacture it. They produce “evidence” only to aid in denying disability insurance claims—even wholly legitimate ones. They do so because there is a strong financial incentive to deny disability insurance claims.
Our firm has dealt with these insurance companies and their private investigators time and again. We know how they operate and how to prepare our clients. We have developed a short list of basic information about private investigators so you can know what to expect:
- When are they watching? In a previous post, we noted the five most popular times for disability surveillance: (1) holidays, (2) birthdays, (3) weekends, (4) activities claimant listed in insurance company’s activity log; and (5) near the end of fiscal quarters.
- Who are they? Typically, private investigators are just as the name indicates – private people from private companies. Disability insurance companies contract with these private companies to conduct surveillance on disability claimants.
- What are their surveillance methods? Particular tactics will vary depending upon the private investigator, the disability insurance company and the disability claimant. However, many methods are common across the board. Basically, the private investigator will inconspicuously follow a disabled claimant with a video-capturing device as the disabled claimant undergoes day-to-day activities. If the private investigator has difficulty locating the disabled claimant, the investigator may use different tactics, such as pretexting, stake-outs or tracking devices, to locate and track the claimant. Our last blog post describes these other tactics in detail.
Senate Finance Committee Hearing Held to Discuss Abuses in Long-Term Disability Insurance Industry
On September 28, 2010, the United States Senate Finance Committee held a full committee hearing titled, “Do Private Long-Term Disability Policies Provide the Protection They Promise?” At the hearing, the Finance Committee and expert witnesses discussed the sometimes abusive practices of insurance companies when handling legitimate long-term disability claims.
Senate Finance Committee Chairman Max Baucus, D-Mont., said LTD insurers use doctors with conflicts of interest to review claims. “Many of these doctors are employed either by the insurance company or by companies that do a lot of business with the insurance company,” Baucus said. “These arrangements make it far too easy for the doctors to deny claims, terminate claims, or reject appeals.”
It’s time for long-term disability insurance companies to clean up their act and treat people fairly. They have acted with impropriety for too long. We need to evaluate the laws that we have on the books and make sure that they are true to their original purpose – to protect people from abuse, and to guarantee that they can get the insurance funds to which they are entitled. Hard-working Americans with long-term disability insurance should not have to deal with corporate abuses if they suffer an injury that keeps them out of work. They are entitled to insurance payments. They should not face roadblock after roadblock to see that money, nor should they face unfair rescissions or payment terminations.
Baucus convened the hearing in response to recent media reports of unfair claim denials and terminations that threaten the livelihoods of those beneficiaries who are unable to work. Both Baucus and the expert witnesses cited instances of long procedural delays and the use of in-house doctors to avoid making claim payments.
Ronald Leebove, a rehabilitation counselor who appeared for the American Board of Forensic Counselors, Springfield, Mo., said private group long-term disability policies fail to provide the protection insurers promise. “There are many tricks and tactics used by the insurance companies to deny claims,” Leebove said.
Baucus stated his desire to work in conjunction with the Senate Commitee on Health, Education, Labor and Pensions to move toward a solution that gives beneficiaries the fair process and justice they deserve.
Video of the hearing and transcripts of testimony are available at: http://finance.senate.gov/hearings/hearing/?id=1c1bd578-5056-a032-5237-4dd9283e52ed
Presenteeism: A Chronic Condition Among Doctors
A new article in the Journal of the American Medical Association suggests that presenteeism—showing up to work with an illness, impairment, or disability that limits productivity—has reached epidemic proportions among doctors. The study, which surveyed residents at multiple hospitals, found that three out of five had continued working while sick. At one hospital, 100% of residents had done so. Half the residents noted that they simply didn’t have the time to see a doctor.
Presenteeism imposes productivity costs on any business, but in the practice of medicine, these costs can include a noticeable decline in the quality of care patients receive. A physician suffering from an illness or disability—or distracted by severe physical pain—can make serious mistakes in judgment, which in turn can have life-threatening consequences for the patient.
Moreover, the presentee habit can become life-long. Later in their careers, physicians may not seek medical care for chronic conditions, injuries, or disabilities, even when they are legitimately unable to work. They may attempt to continue even the most physically and mentally demanding duties, aggravating the injury and putting patients at risk, even when they hold a disability insurance policy that could provide a safety net for their personal and professional finances.
Finally, a change in medical culture may be in order. Doctors should feel comfortable seeking the medical care they need, or even filing a disability insurance claim when appropriate. Dr. Vineet Arora, Associate Professor of Medicine at University of Chicago and one of the study’s authors, argues that “Hospitals need to build systems and create a workplace culture that enables all caregivers, not just residents, to feel comfortable calling in sick. Their colleagues and their patients will thank them.”
