A recent news story about a Toronto woman who was off work because of a head injury and videotaped by the Workplace Safety and Insurance Board (WSIB) is an example of how far insurers will go to deny legitimate claims, says Toronto injury and disability lawyer Nainesh Kotak.
Insurance companies have “tremendous resources” at their disposal to defeat legitimate claims for injuries and disabilities, says Kotak, who frequently represents people whose disability claims have been denied or cut off by insurers.
“They spend millions of dollars a year to conduct surveillance on claimants receiving benefits; it’s in their interest to maintain profitability for their shareholders by denying claims and dispersing minimum payouts,” he says.
Surveillance common in disability cases
A disability insurance company may start surveilling a claimant if they suspect the person is working while collecting benefits or if they discover inconsistencies in reported information, especially if it contradicts what their doctor or other specialists have reported, Kotak says.
“They often hire private investigators to follow disability claimants and speak to their neighbours in an effort to discredit them,” he points out.
The investigators may record photos and videos of the person at the grocery store or socialize with family and friends in an attempt to demonstrate they are exaggerating or lying about their disability.
Claimants need to be completely honest about their functional abilities with their insurance company as well as their doctors and other treatment providers, Kotak stresses. If you’re off work due to a back injury, but the investigator records a video of you helping your brother build a deck, your claim may be jeopardized.
Testing claimants’ credibility
That doesn’t mean claimants whose physical or psychological condition prevents them from working have to remain stuck inside the four walls of their home, Kotak says.
Let’s say Jake is receiving disability benefits following a depression diagnosis. His doctor prescribes medication and therapy and recommends time off work to help him recover. During the first month, he’s completely housebound and reports that to his disability insurer. But in month three, on his psychologist’s advice, he starts taking a daily walk at a nearby park but doesn’t report his progress to the insurance company.
If the insurer has recordings of Jake on his daily walks, but he tells them he hasn’t left the house in four months, his credibility will be questioned.
“Insurance companies request regular updates of a claimant’s progress, so it’s important to be truthful in terms of your functional abilities when you visit the doctor or speak to the insurance company,” Kotak explains.
Recovery isn’t necessarily linear for people living with mental and physical ailments; they may have good days and bad days, and their functional abilities may change –– for better or worse –– over time, he says.
Combatting insurer’s tactics
Disability insurers deploy a large and sophisticated fishing net to gather information about their insured’s activities, reports Plaintiff magazine.
According to the legal news publication, common tools used by disability insurers include:
- Credit checks
- Internet canvassing
- In-person field visits
- Lengthy telephone claimant interviews
- Surreptitious surveillance
- Activity questionnaires
- Attending physician statements
- Telephone interviews with treatment providers.
The magazine goes on to say that the best antidote to a dishonest insurance company narrative aiming to undermine the LTD applicant’s claim is a strong, consistent, well-documented explanation of the medical condition and its effects.
“Claimants should keep contemporaneous records of their treatment, symptoms, side-effects and activities. The best practice for LTD claimants is to get the help of an attorney who can assess the many tricks and traps to avoid and to tell the client’s story persuasively.”
Mind your social media activity
Another way disability insurance companies gather personal information about claimants is by combing through their social media accounts. It’s relatively cheap and convenient to scour someone’s Instagram, Facebook, LinkedIn and Twitter accounts, especially if they aren’t set to private, Kotak says.
The insurance company conducts social media searches to prove you’re exaggerating or lying about your disability. They’re looking for a “smoking gun” that will discredit the claimant’s credibility, and sometimes they cherry-pick information to fit their narrative, he adds.
“People tend to post happy moments on social media, and sometimes what they post is misconstrued by disability insurers,” he says. “If your LinkedIn profile says you’re looking for job opportunities, you may not have updated it in a while, but that could be a red flag for the claims examiner.”
Kotak says he’s had cases where the insurance company produces pre-disability photos from the applicant’s social media in an attempt to discredit their claim.
“This is very aggravating for clients because it reinforces the feeling that the insurance company is out to get them,” he says.
Kotak advises clients to take three important steps on social media:
- Set your social media profiles to private. Insurance companies can ask a judge to order production of the content, but there’s more expectation of privacy if the account is private
- Live your life, but be aware of how your social media posts could be used against you
- Make sure your social media posts are consistent with your functional abilities.
If your disability insurance claim has been denied or cut off and you’re considering hiring a disability lawyer, check our blog post for tips and key questions to ask a lawyer before hiring one.
KOTAK PERSONAL INJURY LAW/DISABILITY LAWYERS CAN HELP YOU
We understand that being denied short-term disability or long-term disability benefits can be devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling a short- and long-term disability claim lawyer at Kotak Personal Injury Law. We have successfully sued numerous disability insurance companies including Manulife, Sunlife, Desjardins, Cigna, Great-West Life, Equitable Life, Empire Life, London Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance, Canada Life, Fenchurch, OTIP, Teachers Life and more.
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