Long term disability (LTD) cases are not decided and then set aside. In many cases, LTD claims are reviewed, especially if an investigation was completed previously but was not conclusive one way or another. Such a case came into an investigator.
In this situation, the claimant had been receiving LTD benefits for several years when an adjuster reviewed the file and decided that it was time to take another look. The claimant was a man who had physical restrictions regarding the number of pounds he could lift and the amount of physical activity he could safely engage in at any time. A previous investigation had not been absolutely conclusive that he was committing long term disability insurance fraud, but the adjuster had a feeling something wasn’t quite on the up and up.
The investigator identified the claimant and over the first two days of surveillance saw him do nothing more than walk out to the mailbox and gather the day’s mail, which was not an indication of disability benefits fraud. But on the third day, the claimant loaded several boxes into the rear of his pick-up truck and drove to the marina on a local lake.
It appeared that there was to be a fishing tournament and he was apparently going to participate. Not only was he participating, he was helping others outfit and prepare their boats and tackle to participate. During that time, he was definitely handling boxes and equipment in excess of the weight restrictions. He was also showing kids how to throw an anchor over the side of the boat.
At a certain time, all the participants started their boats and took off across the lake. Our investigator remained at the marina to gather more data while continuing to videotape. He was able to determine that not only was the claimant a participant in the tournament, he was part of the organizing group and was being paid to run the fishing contest.
The hunch the adjuster had paid off and this disability insurance fraud was brought to an end. As with most insurance fraud, long term disability fraud investigators are looking for documentation that truthfully portrays the situation. Two questions are asked:
- Is the claimant working elsewhere for monetary gain?
- What is the current level of activity?
The answers provide the information insurance adjusters need to properly classify the claim and either pay or terminate benefits.
-Brenda McGinley, CEO, All in Investigations, All in Investigations
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