Requests for field visits should never be considered “routine” or “normal and customary” as insurers like to suggest. Although field investigators have absolutely no authority or control to make claims decisions, information obtained and fed back to claims handlers can be used to justify claims denials.
In today’s environment where “everything you say to insurers” is used against you, it’s important to understand and be prepared to remain in control of the field interview and not allow insurers to “fool you” into showing work capacity where none exists.
For example, recently I heard from two separate insureds that Unum now has a 15 page template of questions field PIs are asked to use when conducting interviews. Insureds and claimants are told the interviews will take 4 hours! The “4-hour rule”, so-called, wasn’t chosen by chance since the capacity to sit, or alternate sitting and standing for 4 hours is identifiable as part-time work capacity.
Insureds need to think for just a moment. Is there realistically any occupational, financial or medical information that should take 4 hours to relate? Interviews that go on and on for 4 hours are those asking personal, and/or family related questions for the purpose of keeping the individual engaged long enough to prove part-time work capacity…
“Do you mow lawns? Laundry? Cook?” “Does your family help you clean house?” These are questions the insurance company wants to know in order to “equate” your daily activities with work capacity to deny claims…
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