Non-Medical Evidence that Disability Insurers Can Use to Deny Benefits

January 15, 2013

The process of applying for disability insurance benefits is not easy. After becoming injured or sick, the claimant must then complete stacks of paperwork in order to file a claim for disability insurance benefits. Among the forms that the claimant must complete is an authorization form that allows the insurer to contact medical sources. But what some claimants do not realize is that the insurer may look beyond the claimant's medical records when making a determination of disability.

The insurance company may utilize a private investigator to surveillance the claimant. This usually means that an investigator will observe the claimant's house or apartment for hours at a time and wait for the claimant to leave the house. The investigator will then follow the claimant to wherever it is they travel and document the activity. Insurance companies may take this evidence and present it to a peer reviewing physician for comment. If a claimant is observed walking in a store for 45 minutes, a doctor can review the surveillance video and opine that the claimant is capable of returning to work.

The Seventh Circuit has held that an insurance company can use this kind of surveillance footage to deny a claimant's disability benefits. In Mote v. Aetna Life Ins. Co., the Court accepted a doctor's conclusion that a claimant was not disabled based on reviewing surveillance video. 502 F.3d 601, 609 (7th Cir. 2007). See also Shyman v. Unum Life Insurance Co., 427 F.3d 452 (7th Cir.2005) (upheld plan's denial of benefits based partially on evidence gathered by a private detective); and Dougherty v. Indiana Bell Telephone Co., 440 F.3d 910, 917 (7th Cir.2006) (upholding ERISA plan's decision to terminate disability benefits after surveillance videotape showed the claimant engaging in normal, everyday activities, such as driving his car and hauling shopping bags).

Video surveillance is not used frequently by insurance companies because hiring private investigators is costly. However, there are other ways an insurer can monitor a claimant's activities. In many cases, an insurance company will conduct an internet search of the claimant's name and location to uncover any red flags. An internet search of the claimant can reveal activities like participating in a 5k walk, volunteering with a charitable organization, or maintaining active membership in an organization. Although these activities may not reveal that a claimant can maintain employment, the insurance company can use this information as part of its review.

An internet search can also reveal participation in social media websites. Sites like Facebook, Twitter, or Pinterest may include personal information that the insurance company can use in consideration of a claim. Any notable activity that is recorded on these sites can likely be found by the insurer when a claimant has a public profile. Even if the settings are set as "private", be sure to carefully review the policies of the social media website to understand who is able to view the user profile. If the insurer is able to view the claimant's profile and learns of activities such as a long vacation at the beach, then this may have a negative impact on their disability claim.

The bottom line is that claimants should be aware of different methods that an insurance company can use to review their claim. Insurance companies look at more than just the medical evidence. If you have any questions about your disability insurance claim, please contact The O'Ryan Law Firm.