WHEN INSURANCE CARRIER SURVEILLANCE RUNS AMOK
Possibly one of the most well known and intimidating methods used by insurance carriers to “disprove” the legitimacy of disability claims is video surveillance. In fact, the image of a “private-eye” type of insurance investigator holed up in a sedan with a camcorder almost has become a cliche. And, this tactic of trying to catch disabled claimants doing things the insurance carrier believes they shouldn’t be able to do (given their disabilities) often results in termination of benefits – many times, unjustly.
Take The Guy Caught Eating A Chip, For Example . . .
Last month, Good Morning America reported that Jack Whitten, receiving disability benefits from The Hartford for pain and memory loss resulting from a broken neck, was caught on video eating a chip. The private investigator for The Hartford videotaped Whitten getting out of a van, entering a bookstore, and of course, chipping and dipping. The doctor employed by The Hartford, who had neither met nor examined Mr. Whitten said, he “was physically capable of performing full-time sedentary occupations.” However, Whitten’s three doctors reported that Jack Whitten was permanently disabled. The Social Security Administration concurred.
Based on this “chip and dip evidence,” The Hartford cut off Whitten’s benefits. No, really, they did. The Hartford claimed, Whitten “had no difficulty dipping chips at a restaurant . . . he could shop, reach, bend, enter and exit a vehicle.” Eventually, Whitten’s benefits were reinstated, but not before the family suffered tremendous financial crisis.
What happened to Jack Whitten might seem unbelievable, but as plaintiff’s attorneys, we see this kind of evidence manipulation on a regular basis.
A Client of Ours . . .
Recently, one of our clients had his benefits cut off based upon an insurance carrier’s surveillance report. The man has been diagnosed with a permanent, debilitating disease and his doctors confirm that he is permanently disabled and unable to work. Yet, despite all of the medical documentation supporting his diagnosis and prognosis, the insurance carrier made our client the target of a surveillance investigation.
In this case, though, our client may have made an innocent mistake. When he first filed his disability claim, he apparently overstated his physical limitations – this is something that many legitimately disabled people do, sometimes feeling insecure or uncomfortable about making a claim in the first place. Or, when first filing for disability, some people may be in the midst of a serious exacerbation of their illness which often affects how they report their perceived limitations.
Our client’s condition was and is more than serious enough to fit the definition of permanently disabled. By overstating his physical limitations at the outset, he raised a red flag for the insurance carrier, and led the carrier to use surveillance in order to disprove his disability.
It is important to understand that when you are permanently disabled, you do not have to embellish on or overstate your physical limitations. We continually tell our clients that being disabled does not mean confined to a bed or a wheelchair. Rather, disabled means that you cannot perform your job as you had always performed it, or as it is performed in the national economy. Sticking to the pertinent facts at the beginning of the claims process will go a long way towards both obtaining and keeping the benefits you have worked for and deserve.
On the other hand, insurance carriers being what they are, there never is any way to guarantee that after you have begun to receive your disability benefits, your carrier will not decide to investigate you with the goal of terminating your benefits. Remember, in most cases, insurance carriers are in business to make money and keep as much of it as they can. That often means finding ways and reasons to deny and cut off benefits. While the case of Jack Whitten losing his benefits due to a “chip and dip” incident may seem extreme, that kind of manipulation of evidence occurs on a daily basis.
Your Best Defense . . .
When it comes to filing for disability and maintaining your benefits, the best course of action is to seek the advice of an attorney experienced in disability law. Remember, video surveillance is merely a snapshot, and not a complete picture, of your disability. An experienced attorney will know how to respond to your carrier if they have been “spying” on you.
USPS Still Struggling
Despite a combined cost-cutting strategy, including a reduction in millions of work hours, facility closings, and early retirements, the United States Postal Service (USPS) ended fiscal 2009 with a $3.8 billion deficit. Currently, the USPS awaits Congress’s decision on whether to approve a five-day mail delivery schedule as well as changes in retiree health benefits funding. Yet, most experts agree that these changes will not ward off all further deficits.
Largely, the financial troubles at USPS can be attributed to the decline in mail service; no surprise given the wide-spread use of email and fax machines. However, labor costs contribute heavily to the deficit, and USPS officials hope that 2010 will see labor cost reduction mainly through attrition. This past year, nearly 20,000 postal employees accepted $15,000 buyouts (these retirements will take effect next year). In the last year and a half, approximately 29,000 postal employees took early retirement.
Legislative News . . .
Last month, Senator Tom Harkin (D-IA), chairman of the Health, Education and Pension Committee(HELP), announced an investigation into the pricing practices of health insurance companies in the small market.
Says Senator Harkin, “For small business premiums to skyrocket, all it takes is one diagnosis for one employee – or the spouse of one employee. All is takes is one older employee, a drop in the number of employees in the business, or a pre-existing condition . . . At this hearing, I would have liked to question health insurance companies about these trends and practices. But not surprisingly, insurance companies are not interested in discussing them. So today I am announcing my own investigation into the pricing practices of health insurance companies that sell policies to small businesses. Health insurance companies should open their books and explain to the American people why they support a health insurance market for small business that is so dysfunctional and so lacking in transparency.”
Senator Harkin sent letters to Humana, United Health Group, Wellpoint and Aetna requesting that they provide the HELP committee with the methods they use to set rates and premiums. Additionally, Harkin asked for compensation information on insurance company personnel who earned over $5,000,000 a year.
DOD Task Force On Sexual Assault Submits Findings, Recommendations . . .
Source: defense.gov
The DOD Task Force on Sexual Assault in the Military Services recently submitted its congressionally-mandated report to the secretary of defense. The report finds DOD has made progress in improving response to victims’ needs, but calls for DOD to do more to fully address the spectrum of sexual assault prevention and response.
“Our recommendations highlight the need for institutional change to more effectively prevent sexual assault and address related issues. Doing so is not only ethically and morally correct, but also essential to military readiness – all the more critical at this time,” said Louis Iasiello, task force co-chairman.
The task force made a number of recommendations involving DOD’s Sexual Assault Prevention and Response Office including temporarily elevating oversight of this office to the jurisdiction of the deputy secretary of defense until the program meets established institutional goals; changing the budgeting process to overcome inconsistent funding among the military services; strengthening the policy and oversight functions of the office; calling for collaboration with the military services and national experts in sexual assault prevention to develop a comprehensive prevention strategy and a plan to routinely evaluate it; and more rigorous oversight of military service training programs.
The task force found DOD has made demonstrable progress in providing assistance to victims of sexual assault by offering restricted reporting which permits a victim to obtain immediate care and counseling without engaging law enforcement and command authority.
The task force did recommend, however, that Congress should, as a permanent measure, enact a comprehensive military justice privilege for communications between a victim advocate and a victim of assault.
Among other recommendations:
- Ensure service members who report they were sexually assaulted are afforded the assistance of a nationally certified victim advocate;
- Ensure victims understand their rights including the opportunity to consult with legal counsel to minimize victim confusion during the investigative process;
- Improve medical care for victims of sexual assault, particularly those in deployed areas;
- Ensure gender-appropriate care for male victims;
- Inform victims and service members of disciplinary actions related to sexual assault.
The task force based its assessment on data collected over a 15-month period at 60 sites around the world. Task Force members spoke to more than 3,500 people, interviewing active duty and reserve component victims of sexual assault and other military personnel. During their assessment, they also interviewed general court-martial convening authorities, legal and investigative officials, senior policy officials, sexual assault response coordinators, and victim advocates.