INSURERS USE SOCIAL MEDIA TO INVESTIGATE DISABLED CLAIMANTS

Disability insurers — both long-term and short-term — now regularly investigate the social media profiles (i.e., Facebook, Instagram, Twitter, etc.) of their policyholder-claimants to determine the legitimacy, nature, and extent of the asserted disability that forms the basis of an insurance claim.  This has justifiably made disability claimants anxious, given the extensive social media presence that many people have constructed.

How will your insurance claim be affected by posts made on social media?

The use of social media to investigate disability claimants is simply an extension of an age-old practice.  In the past, insurers would hire investigators to follow claimants and photograph them while engaged in activities that undermine the legitimacy of the disability claim at-issue.  For example, an insurer might be able to escape having to pay out for a policyholder’s long-term disability claim if they investigate and photograph the claimant (who purportedly has a debilitating back injury) engaged in physically demanding sporting activities.

Naturally, insurers have taken to social media to further investigate the claims of their policyholders and to give them reason to deny what would otherwise appear to be legitimate disability claims.  As a disabled policyholder, it’s critical that you understand the ways in which insurers utilize the results of their social media surveillance and how you can challenge the assumptions made by insurers on the basis of a social media investigation.  With the assistance of an experienced Houston disability insurance lawyer, you can outmaneuver the insurer and their investigation.

Let’s briefly consider some of the unique issues associated with a social media investigation in the disability insurance context.

TAKING SOCIAL MEDIA OUT OF CONTEXT

Suppose that you have filed an application for long-term disability benefits on the basis of a serious medical disorder that prevents you from holding down a consistent job.  The insurer begins an investigation into your medical history and even launches an investigation into your social media profiles (without your knowledge).  Over the past year, you have engaged in a number of physical activities — perhaps you went hiking with friends during the summer — and posted the photos to social media.  The insurer subsequently denies your claim, arguing that your social media activity proves that you are not disabled, and that your physical condition is sufficiently “good” to allow you to work.

Of course, as the disability claimant, you should always avoid posting anything to social media that could be construed against you by the insurer.  In situations where the insurer has already investigated your social media, however, you may be able to effectively argue that the insurer has taken your posts out-of-context and misinterpreted your condition.

How?

Consider that one can be legitimately disabled and unable to work, without necessarily being incapacitated by their disability at all times.  For example, if you have an immune system disorder, then you may have “spikes” of illness that render you bedridden.  At other times, however, you may be healthy enough to go on a hike or go out for drinks with family and friends.

The fact that you post such moments on social media is not indicative of your overall, day-to-day ability.  Social media posts for many users are a matter of highlighting specific and interesting moments — they are not a perfect record of one’s daily activities.  As such, if an insurer attempts to draw conclusions about your disability on the basis of a few social media posts, they are likely misinterpreting your social media and what it indicates about your condition.

SOCIAL MEDIA CANNOT BE SOLE BASIS OF DECISION

Courts have allowed insurers to deny disability benefits pursuant to evidence procured from the policyholder’s social media profiles, but it’s important to note that social media evidence is usually insufficient as the sole basis of a denial.  Generally speaking, there must be additional reasons supporting the denial, such as inconsistent medical records.

As a disability claimant, make sure to conduct your own personal investigation into your social media profiles to “clean up” anything that is likely to be misconstrued by the insurer.  Insurers are not your allies.  They will look for any means by which to undermine your claim and justify a denial, so it’s crucial that you make efforts to properly shield yourself from their inevitable social media investigation.

CONTACT A HOUSTON DISABILITY INSURANCE LAWYER TODAY

If you have had your legitimate disability insurance claim wrongfully denied by an insurer, undervalued, or unreasonably delayed, then it’s important to get in touch with an experienced Texas disability insurance attorney here at Berg Plummer Johnson & Raval, LLP for assistance.  With the aid of a qualified attorney, you can effectively repackage your application for disability benefits, or in the alternative, appeal the denial of benefits.  If all else fails, you can even sue the insurer on the basis of wrongful denial and bad faith.

HEALTH INSURANCE CLAIM DENIALS: AETNA DOESN’T REVIEW MED RECORDS

Recently, in a California insurance lawsuit involving the wrongful denial of health insurance benefits to a 19-year old claimant suffering from a rare immune-system disorder, a former medical director at Aetna (the defendant health insurer) admitted under oath to having never reviewed patient medical records when determining whether to deny health insurance claims.

The testimony of Dr. Jay Iinuma — former Aetna medical director — has sent shockwaves through the health and disability insurance world, including Texas.  Health insurer Aetna is now under intense scrutiny and is currently being investigated by the California insurance commissioner for potential violations of insurance law.

Importantly, the testimony of Dr. Iinuma is not merely a smear on Aetna.  It is indicative of larger, more systemic issues with claim assessment.  All too often, insurers rely on their industry reputation, and they abuse their power.  Insurers — even those as prominent and well-reputed as Aetna — consistently fail to adhere to their own procedures and in doing so, they deny legitimate claims made by their policyholders, thus exposing such claimants to a range of financial, emotional and physical pressures.

How does this affect health insurance claimants such as yourself?  If you believe that your claim has been wrongfully denied, you may want to speak with a qualified Houston health insurance claim lawyer for further guidance.  Let’s explore some of the basics of wrongful denial and the potential consequences of an insurer’s failure to adhere to their legal duties.

WRONGFUL DENIAL AND BAD FAITH

In Texas, insurers must act in good faith towards their policyholders.  If they fail to act in good faith and engage in fair dealing in handling the claims made by their policyholders, they could be held liable for bad faith and exposed to significant damages.  Damages may include financial losses, pain and suffering, emotional distress, and punitive damages.  Though punitive damages are rarely awarded, in situations where the insurer clearly and egregiously violated their moral duty — such as the situation with Aetna — punitive damages may be available.

When an insurer denies your health insurance claim, there must be a reasonable basis for them to do so.  If the insurer unjustifiably denies your claim, then they may not have engaged in good faith when assessing your claim.  The fact that Aetna medical director Dr. Iinuma did not review medical records when making medical necessity determinations was undoubtedly a violation of their duty of good faith, and those whose claims have been denied by Aetna may be justified in appealing their denial or suing Aetna for wrongful denial and bad faith.

In the months following Dr. Iinuma’s surprising testimony, Aetna has argued that it does, in fact, have employees assess the medical records of each claimant when determining whether to deny a claim.  Regardless, in making a bad faith claim (against Aetna or another insurer), your attorney will have to prove that your claim, specifically, was unjustifiably denied.

SPEAK TO AN EXPERIENCED HOUSTON HEALTH INSURANCE CLAIM LAWYER TODAY

If you have had a health insurance or disability claim wrongfully denied, delayed, or undervalued by Aetna, or any other insurer, then you should work with an attorney to challenge the insurer’s decisions, or if necessary, to sue and recover damages as compensation for your losses.  Connect with an experienced Texas health insurance attorney here at Berg Plummer Johnson & Raval, LLP for assistance.

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