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Disability insurance claims adjusters are trained to locate what is referred to as "red flags" within the claim file documentation you provided to the insurance company in support of your claim. Examples of "red flags" are: inconsistent information provided to the insurance company, or, in some cases simply a "gut feeling" of suspicion about the claim. Most disability claims are investigated by using surveillance, either as a "tag surveillance" for an Independent Medical Evaluation (IME), or very early (or late) risk management intervention.

The actual questions provided to field surveillance representatives are often the result of the degree of expertise and experience the claims adjuster has for identifying what is referred to as "inaccurate, inconsistent, and suspicious information." Self-reported impairments such as fibromyalgia, CFS (Chronic Fatigue Syndrome), Lyme disease, RSD (Reflex Sympathetic Dystrophy, MS, headaches, back complaints, vertigo, dizziness, fatigue, and other "self-reported claims are particularly subject to surveillance referrals.

The claims adjuster may request a detailed activity data base check. This includes information regarding your driving record, properties owned, licenses held, court actions, bankruptcies, credit rating, marriages, divorces, pharmacy records, records of children (with the same surname), criminal records, unemployment history, child support records, court records, employers, military records, aliases --well, you get the idea. This data base check tells your insurance company more about you than even you may know.

Some disability insurers now have the ability to research the number of frequent flyer miles you have, golf or country club memberships, tee times, exercise club facilities, etc. As a general rule, I always tell my clients to assume the insurance company knows everything you do.

Remember the authorization release you signed? Your disability carrier may use this release to perform a FICA check to see if you have been working and not telling the insurance company. Since earnings from employment are an offset (reduction) to benefits, the insurance company has a vested interest in making sure you have reported all your employment earnings.

Therefore, employers are contacted, as well as your neighbors, friends, or co-workers. If you ever thought your privacy was being invaded, this is certainly it, although almost every disability carrier claims they have a right to surveillance to uncover potential insurance fraud. Insurance fraud statements are written into nearly all new policies.

Next, the claims adjuster may ask the field investigator to tape you on video, producing a visual CD/DVD/Digital record of your activity for three days. If the surveillance team does not locate you immediately, they may use a ruse of some kind to call you at home to determine your whereabouts.

The caller may identify himself as a courier for the "US Purchasing" company, or another type of delivery service. They usually ask questions like, "Is there another location where we may reach you today?" Or, "If you aren't home, where can we get in touch with you?" Obviously, the investigators are attempting to find out if you are working or going to another location on a regular basis.

The surveillance team is highly skilled in evasion surveillance, very rarely blowing their cover, since the majority of insured's do not suspect the insurance company of such activity.

Although by law the surveillance team is required to obtain neighbors' permission to watch you if they must go onto adjoining private property, they frequently do not. Always be aware of following cars or persons sitting in cars near your home or property. Some surveillance teams notify the local police of their surveillance activity to avoid police response and intervention, if spotted. The average time frame for surveillance is 3-5 days, which may cost the insurance company $2,000-$5,000. In addition to the CD/DVD provided to the claims adjuster, an hour-by-hour written report is also sent as a permanent part of your disability claim. Most surveillance teams will notify the claims adjuster by phone and discuss an initial report before and after the actual DVD arrives.

Physicians and as many as 25 person (including management) attending a roundtable or "huddle" discussion will review the surveillance report and DVD provided to the claims adjuster. A copy is sent to your attending physician for comment. If your physical activities are inconsistent with your diagnosis and reported activity, your physician may contact the insurance company and change his/her medical opinion, releasing you to return to work. This surveillance record becomes a permanent part of your claim file documentation and follows your claim, even to the appeals level or before a judge. Physicians can often be easily persuaded to release you to return to work activity when faced with a persistent insurance representative and convincing surveillance.

The disability insurance company's internal protocols prevent the claims' adjuster from providing you a copy of the surveillance report until a final liability determination is made. If your claim is denied, all documents related to any surveillance activity must be provided to you along with your claim file.

A surveillance tactic commonly used by disability insurers is called "tag surveillance." If you have been asked to submit to an IME, the process is as follows: The claims adjuster will call you a day or two before the examination and question you in detail concerning your functional activity and medical status. A surveillance team is assigned to observe you on video a day before, the day of, and the day after the IME. The purpose of "tag surveillance" is to actually "catch" you engaged in activities you may have said you couldn't perform before the IME. Inconsistent reporting of physical activity can be used adversely if the disability insurer is able to record you engaged in activities you previously reported you couldn't do.

Remember, no disability claim can be denied solely on the basis of surveillance, since there is no such contractual provision in your policy which allows disability insurers to do so legally. Surveillance results are strictly "out of contract." What the disability carrier will do, however, is submit the surveillance DVD to your treating physician with a request to reconsider their previous certification of your inability to perform productive work. If the physician agrees and releases you to return to work, your claim will be denied. In my experience about half of the physicians presented with visual evidence actually do reverse their disability certification and sign releases for work. Visual surveillance is VERY CONVINCING!

Be cautious. The disability insurer, and its outsourced agents have spent many years developing surveillance methods of locating database sources of information reflecting negatively on your credibility as a claimant. Management trains all claims adjuster in the identification of "red flags", and no insured is immune from surveillance if their monthly benefit is high enough to support the cost of surveillance.

What does this mean? If you expected to receive a monthly benefit ranging from $100 to, say, $2,000 per month, you may be less likely to be surveilled, although not immune from it at any point in the claim history. As stated above, your monthly benefit would need to be high enough to warrant the cost of surveillance.

In conclusion, be mindful of the authorizations you sign for any insurance company and exercise extreme caution how you communicate with representatives identifying themselves as claims specialists. Be aware of unusual people in your neighborhood; ask neighbors to tell you if anyone has been inquiring about you. If you identify someone following you and feel uncomfortable, notify your local police department and ask for an officer to terminate the surveillance.

Assume all public records about you have been obtained by the insurance company. And, finally, talk to your doctor candidly in advance regarding your impairment and restrictions from work. Discuss the possibility of surveillance by the insurance company in advance, and continue to have open and honest conversations with all your treating physicians. As your physician to notify you immediately of any surveillance information or additional requests for medical information received.

Because you have submitted a claim for disability benefits, your insurance company will scrutinize your past and current activities at a time when you are not feeling your best. If at any time you are not feeling well enough to communicate with your claims adjuster, ask to reschedule the call and plan your conversation in advance. Obtain a copy of your policy, and read it carefully. Knowing your rights under the policy provisions can mean the difference between benefits denied, and benefits paid.

Should you feel scared, intimidated, or threatened by a surveillance team, notify your local police department. At that time, the surveillance will have been identified and, for all intents and purposes, the activity is over. If you feel safe to approach a person who is watching you, you may do so and request the termination of the surveillance. Once the cover is blown, the activity is generally terminated.

Remember, surveillance is used most often to identify "inconsistencies of reported activity." If you tell the insurance company you cannot lift anything and are subsequently observed lifting feed sacks into the barn, chances are your claim will be denied. Again, this is a very good incentive for being honest with insurance company about your activities.