What the Insurance Investigator Doesn’t Want You to Know
When you file a long-term disability claim, it is common for the insurance investigator to call you and ask casual questions about your health and daily life. Next, they will say, “We want to send someone to your home to meet with you to discuss your claim.” This is called a field interview.
Do not be fooled! They are not calling to check on you because they care. The insurance company will say they need to meet face-to-face to discuss how you are doing, but field interviews are used to discredit claimants filing for disability. They are looking for inconsistencies in your story to prove to a judge that you are lying about your disability.
Tips to Prepare You for a Field Interview:
Thanks to modern-day technology, insurance companies will have your complete background at their fingertips. They can access your medical history, credit report, liens or bankruptcies, child support, and delinquent payments. During the field interview, they will use this information to trick you into saying something that makes you appear dishonest. Go over this information with your attorney before the field interview. Plan to be asked some tough questions and stay calm. Your attorney will help guide you through these tough questions.
Sometimes, insurance investigators will put you under surveillance before your interview. They will question your neighbors about your daily activities. They will watch you and follow you to see if you are doing anything that you said you couldn’t. They will record you.
Be vigilant! Please do not overdo it. Sometimes, your doctor may encourage you to continue your daily life to speed up your recovery. Still, an insurance investigator sees this as you telling a lie about the severity of your condition. Although the actual surveillance cannot be used against you, the insurance company will ask your doctor to look at the tape and comment on your physical activities that can affect your case.
When the insurance company calls to “check on you,” they will try to persuade you to have the field interview in your home. They are trained to speak a certain way to make you feel you have no choice.
That is not true.
You have the right to have your field interview at another location, and you should. Why? The insurance investigator is trained to go into your home and take notes on how to live. If you have a large TV, if your home has stairs, if you have pets, or if other people are living there. They will use all of this to build a case against you. You do not have to let them in your home. Arrange for the meeting to be somewhere else.
You Have the Right to Have Your Attorney Present
You have the right to have your attorney present. An insurance investigator might discourage you from bringing your attorney by implying it is just a simple face-to-face conversation. Don’t let them fool you. Your attorney is trained to assist you and support you. Having an experienced attorney present will help to prevent you from getting intimidated by the insurance company.
Preparation is Important
Your interview will go smoothly if you spend time preparing yourself for the interview. Let your neighbors know that there is a possibility that an investigator will come to see them to snoop around. Take it easy, and don’t push yourself in the days before your interview. Go over anything that may come up during the interview with your attorney. Although field interviews can be scary, you can get through them if you prepare properly.
Does A Claimant Have to Permit the Field Interview?
First, does an individual have to participate in a field interview? You are probably here because you are wondering, “Hey, the company just called me. Do I have to meet with them to engage in this field interview?”
As you will see time and time again on this website, your obligation to participate in the field interview comes down to (i) the policy and (ii) the obligations and requirements under the terms of that policy. Most policies do not require that you participate in the field interview process under their proof of loss requirements. However, some policies do. Therefore, it is essential to carefully review your policy’s proof of loss requirements to determine if you first have to participate in that field interview with an insurance company representative.
Should A Claimant Voluntarily Participate in the Field Interview?
Assuming you are not required by the long-term disability insurance policy to participate in a field interview, you should still weigh the pros and cons of meeting with the representative versus not meeting them. You do not need to worry because the insurance company called for one. For some insurance companies, field interviews are simply routine. They may have a protocol where they say, “Every two years, we’re going to send someone out to meet with you.” And that is just the way that a particular company handles its claims.
However, there are certain companies that, if they’re calling you for a field interview, it is not a good sign. For example, the insurance company may have just completed a week of video surveillance on you. Now, they will try to enter your home, sit you down, and go through a specific line of questioning with you. The representative may make you feel comfortable with them. They’ll tell you they’re not there to harm you or your benefits.
Then they pop open their laptop computer and say, “Oh, can you explain what you’re doing here and why were you able to move in this way? And why didn’t you report it to the insurance company?” You may feel like you have your back against the wall and you’re just saying random things in self-defense. The next thing you know – the insurance company uses your statement to deny your claim or terminate your benefits.
Representation By An Attorney?
For this reason, we recommend that you never undergo a field interview without representation from an attorney. If you intend to move forward independently, you should be prepared. You want to prepare with someone familiar with the process who could explain what to expect at the field interview. Again, please do not believe the insurance company is going to your house because they care about you and are looking out for you. You must understand that they are looking for sufficient evidence to deny your claim.
The Importance of a Field Interview in the Claim
In many cases, the field interview process is benign. The field interviewer may be there to obtain an update, review some additional questions with you, review some recent medical treatment you’ve had, update your medical folder, including your current list of doctors and why you are seeing them, etc.
In short, it is like preparing for a hurricane. You do not know if that hurricane will hit and destroy your home, but you go through the preparations to ensure that you will limit the damage. The same preparation needs to occur with these field interviews. It would help if you prepared yourself so you do not cause much damage to your disability insurance claim.
Who Is Conducting the Field Interview?
There are a couple of different scenarios that you might see during a field interview. For example, MetLife is employing some full-time field interviewers. These representatives work for MetLife and conduct the interviews. Hartford has some full-time employees who perform interviews as well. On the other hand, Unum may hire a third-party company to conduct the field interview. These third parties may not know much about your disability claim except for perhaps what’s on the one-page summary the disability insurance company sent them.
There can be a lot of frustration with an interview conducted by a third party. That’s because this person may come to your home, ask you questions for several hours, ask you tons of questions that are already answered in the claim file, and ask you a bunch of questions that may be wildly inappropriate. We try to eliminate duplicative and inappropriate questions to make these meetings go as quickly as possible. You should not have to sit for the interview any more than you have to.
Ways Insurance Investigators Try to Trick You and How to Avoid The Traps
Do Not Have an Interview In Your Home
Most insurance examiners will try to insist that you have the field interview in your home. They want to come inside your home and take notes on how you live, whether you have stairs, whether your home is tidy, who you have living there, etc. Your attorney will advise you to meet at a neutral location to protect you against this.
Be Aware of Surveillance Before and After
Surveillance is a tactic the insurance company uses to find holes in your story. In the days before and after your field interview, they will question your neighbors about your daily activities, watch you, and follow you to see if you are doing anything you said you couldn’t. They will record you. Be vigilant.
Don’t Overdo It
Sometimes, your doctor may encourage you to get on with your daily life to speed up your recovery. This may be a well-meaning intention by your doctor, but an insurance investigator sees that you are ready to return to work and not disabled. Although the actual surveillance cannot be used against you, the insurance company will ask your doctor to look at the tape and comment on your physical activities that can affect your case.
What To Do During A Field Interview
Have Your Attorney Present
You have the right to have your attorney present. An insurance investigator might discourage you from bringing your attorney by implying it is just a simple face-to-face conversation. Don’t let them fool you. Your attorney is trained to assist you and support you. Having an experienced attorney present will strengthen your case and keep you from getting intimidated by the insurance company.
Be Prepared For Tricky Questions
The insurance investigators are trained to ask you questions in several ways to trick or confuse you. They may bring up things from your past, like your credit history, child support payments, liens, or bankruptcies. This makes you uneasy and makes you accidentally say something they can use against you later.
The investigator asks some common questions that are meant to trick you. Work with your attorney to prepare for these questions. The more prepared you are, the more comfortable the field interview will be. Here are some common field interview questions:
- How are you feeling?
- How is your recovery coming along?
- What are your current symptoms?
- What are your current limitations?
- Where are you receiving treatment?
- When was your last appointment?
- How often do you see your doctor?
- Do you see any specialists?
- Have you been prescribed any medication?
- Are you taking your medication as prescribed?
- Are you participating in any behavioral therapy or outpatient programs?
- Have you undergone any psychological or neuropsychological testing?
- Do you have any referrals pending now?
- Are you scheduled for any diagnostic testing? MRI, etc.?
- How would you describe your pain?
- Are there any activities that aggravate your pain?
Return to Work
- What was your previous occupation?
- Could you return to work in that position?
- How do your symptoms keep you from returning to work?
- Have you discussed returning to work with your treating physicians?
- When do you think you could return to work?
- Do you feel like you could return to work in any capacity?
Restrictions and Limitations
- What is the maximum distance you can walk?
- What is the maximum time you can stand?
- What is the maximum weight you can lift and carry?
- What is the maximum time you can sit?
- Are you able to drive?
- What is the maximum distance you can drive?
- Can you bend at the waist?
- Can you twist at the waist?
- Can you twist your head left and right?
- Can you squat and stand up?
- Can you push or pull items that offer resistance, such as a mower?
- What is your dominant hand?
- Do you have full use of your hands and fingers?
- Can you write with a pen/pencil?
- Can you type?
- How would you describe your computer skills?
- Do you have difficulty using electronic devices?
- Do you have any visual impairments?
- What do you do during the day?
- Do you read books or watch TV?
- Do you provide care for any other person?
- How long are you able to shop at the grocery store?
- Do you prepare meals?
- Do you clean your own home?
- Do you do any light cleaning, such as wiping the counter?
- Do you do your laundry?
- Do you make your bed?
- Do you do home maintenance tasks such as taking out the garbage, mowing the lawn, etc.?
- Do you participate in any social or recreational activities?
- Do you spend time with family and friends?
- Do you have any hobbies?
- Have you traveled anywhere while on claim?
- Have you worked for anyone while on claim?
- Do you receive any income from work activities?
- Do you use any social media platforms, including but not limited to Facebook, Instagram, Snapchat, TikTok, or Twitter?
- How much time do you spend on social media per day?
- Are you a social media influencer?
- Do you receive any compensation for your social media activities?
- Do you have any online jobs?
- Do you participate in any volunteer activities?
- Do you hold any elected positions?
- Do you have any professional licenses?
Personal and Financial
- What is your highest level of education?
- Have you taken any classes or worked towards obtaining a degree or certificate since filing for disability?
- Have you filed any lawsuits since filing your disability claim?
- Do you receive other income from unemployment, workers’ compensation, the Social Security Administration, etc.?
- Have you filed any other disability claims?
- Did you understand all the questions?
- Were all your answers true and accurate?
Provide Explanations When Needed
The investigator prefers you to answer “yes” or “no” to their questions. But if your response begs a further explanation, don’t hesitate to speak up and give one. The investigator may try to cut you off or move on to the next question, but continue with your answer until you are finished. Also, do not give more information than necessary. Giving them too much information will allow the insurance company to twist your words. Answer the questions directly, but don’t hesitate to explain when needed. A field interview can feel a lot like an interrogation. Do your best to remain calm.
It will go smoothly if you spend time preparing yourself for the interview. Let your neighbors know that there is a possibility that an investigator will come to see them to snoop around. Take it easy, and don’t push yourself in the days before your interview. Go over anything that may come up during the interview with your attorney. Although field interviews can be scary, you can get through them with proper preparation.
Recording the Field Video
Some claimants ask, “Do I want to record these field interviews?”
There are primary ways to record the field interview: (1) video recording, (2) audio recording, and (3) having an actual court reporter present.
Some of these options may add costs to the claim, but there are advantages to recording the interview. For example, the field interviewer’s report may have inaccuracies. They write down things you purportedly said, but they are not what you actually said. It would be good to have evidence to combat inaccuracies.
But if you are not going to record, you should ask for a written transcript of the interview and a copy of the field interviewer’s report. You may even ask to review a copy of the interviewer’s notes. Wouldn’t you want to see everything that’s being written down? You could sign off and say, “Yes, I said A, B, C, D, and E.” But remember that the companies won’t often give you their notes.
Legal Representation by Experienced Long-Term Disability Attorneys
If you’d like to speak to an experienced Long-Term Disability Insurance Attorney about your denied claim, contact us at (888) 321-8131 to schedule a consultation. Although based in Florida, the Ortiz Law Firm represents claimants across the United States. We can help you evaluate your claim to determine whether you qualify for Long-Term Disability Benefits and how to navigate through the appeals process if your claim has been denied.