Insurance Investigators: An Inside Look At Their Techniques

We’ve often mentioned insurance company investigators and their tactics as extremely adept at developing reasons to deny legitimate disability claims. Insurance companies like to hire former FBI agents and police detectives who have been specifically taught to treat their targets as adversaries and be cynical of any answers – which they innocently refer to as being professional. These investigators have undergone specialized training on how to dig up information and how to conduct interviews that can be twisted against claimants and used by claims examiners to deny disability claims. Due to our connections, our firm has seen some of the confidential training materials used by disability claims operations that help provide insight into the investigative techniques and methods used to interview claimants. This information can be invaluable to claimants, allowing them to more properly prepare for the interview, whether it’s a scheduled appointment or an unannounced visit. Today’s blog is going to breakdown and summarize some of the key points to help you handle an interview and understand the underlying purposes for the questions.  

Knocking on the DoorUsually, investigators will be very charming and charismatic. This is meant to make the claimant feel more comfortable and willing to answer wider ranges of questions and go into more details with less suspicion than if the investigator was cold and impersonal. They’re trained to make themselves as appealing as possible to make you as comfortable as possible in the interview, so you’ll let your guard down and mention something that can be misconstrued against you and your claim. A good investigator uses three basic tools in an interview: they’ve done background research; they ask open-ended questions; and they pay close attention for verbal (and non-verbal) cues. Before an investigator even meets you, they’ve already done significant research and know all about you, your claim, and your life. Many of their questions are asked just to gauge your truthfulness and assess your mannerisms to get a baseline of your behaviors when you’re answering questions. We cannot stress enough that you should always tell the truth, as these people are experts at realizing when they’re being misled or lied to – otherwise called defective truths.

One of the most effective techniques is simply to ask open-ended questions and then wait for you to ramble on in your response. You see, they’re trained to use awkward silences to their advantage. Simple, open-ended questions serve two purposes: it keeps them from revealing the specific aspects of the claim they’re actually focusing on, and they can gather as much information as possible, potentially expanding their scope beyond a limited, specific answer and allowing them to gather more information about new avenues of inquiries that they can explore. When you’re asked these questions, simply and calmly answer the exact question asked. If the question’s too broad or you don’t understand exactly what is meant, make the investigator be more specific. For example, instead of asking you what duties you’re no longer able to do, they may ask you to describe in detail everything you did on a certain day from the time you woke up until you went to bed. Another example is any question that beings with “tell me about…..”  Claimants want to cooperate as much as they can, so these types of open-ended questions are often stressful and overwhelming. If this is the case, clearly and calmly tell the investigator and have them phrase the question in a more manageable way. If they refuse and keep pressing for an answer, make sure that you carefully records any specific intimidating or unprofessional behaviors.

There are certain claim topics that investigations often cover. Knowing these topics can be crucial to your claim and allows you to prepare ahead of time, removing at least some of the element of surprise from the tools of the insurance investigators.

  1. First impressions. The insurance company will have investigators notice the exterior and interior surroundings when at a claimant’s residence. They’re trained to quickly take notes about the neighborhood, physical checklistconditions of the interior and exterior of the house, any vehicles, and any suggestions of occupational or recreational activities, such as a workshop, work desk/office, pool, garden, or watercraft. This information can be used to infer your activities and create reasons to deny your claim. If you own a boat, for example, they may say that shows evidence of your ability to participate in recreational activities. The investigators also constantly monitor your physical movements and actions during the interview to report back to the insurer for comparison with the claimed restrictions and limitations.  For example, investigators will attempt to extend the amount of time you sit to “verify” your disability due to a spinal condition.  Even the strength of a handshake has been used as a reason to deny a carpal tunnel syndrome claim.  
  2. Background. Investigators have detailed descriptions of you, your family members, and your co-workers. This includes information such as how long you’ve been married, where your children go to school, and the activities of your spouse and children. Why? They’ll use this information to try to create common bonds with you. And as a bonus, how you’re involved in your family’s activities will be examined for conflicts with what’s been reported on your claim forms. Insurance companies often assume that if your family is involved in an activity, then you must be as well.
  3. Education. Investigators will ask about your level of education and any special training you may have received prior to your job. If your coverage is for any occ, this data can be leveraged to try and identify another potential job that you may be qualified for, even with your current disability. Conversely for own occ claims, it’s important to be thorough and fully explain all of the training and experience that went into your current occupation so they don’t water down your job duties and compromise your claim.
  4. Employment.  Considering your previous education, training, and experience, claims examiners and vocational consultants use this information to identify a job you could potentially work to terminate LTD claims. Some companies ask for the previous 10 years of detailed employment data. When the scope of the questions are this enormous, it’s fine to push back and ask why this information is needed and whether you’re even required to provide it. If your occupation 10 years ago has nothing to do with your current disability claim, there’s seldom a reasonable excuse as to why it’s needed. Investigators may also ask questions about absences and sick leave from work, or if you’re currently looking for a job. The investigator may ask you to recollect a typical workday before your disability. They know you’ve already answered those questions on the claim forms – they’re just attempting to discredit those answers. Make sure that you’re thorough and detailed when answering this question, clearly connecting your disability to your occupational tasks. Our blog post on creating a beneficial job description may help you construct this answer. Remember, you’re only required to provide answers to reasonable, allowable questions.
  5. Medical history. This is a critical part of the interview for both the claimant and the investigator. Investigators are looking for your history of hospitalizations, surgeries, medications, and any other medical complications you may have had in the past. Using this post on preparing a medical history document will help you have this information at hand and only provide what’s required. Remembering all of your medical information is difficult and honest mistakes are often made about this topic in an interview. But from an investigator’s perspective, there are no honest mistakes. Having claimants use a scale of 1 to 10 to describe pain is also specifically recommended in training materials. Since these investigators are not trained medical professionals and quite probably neither are you, it’s not appropriate for them to insist that you rate your pain on a scale. Politely decline to “rate” your pain and describe your issues and symptoms subjectively as you have in the past and on the claim forms.
  6. Treating physicians. This is an easy topic that should be included in your medical history document. The investigators are looking for clues for a lack of appropriate care and the frequency of a claimant’s treatment. For more information on appropriate care and how the insurance companies manipulate this clause, read our blog post here. If you follow your doctor’s orders and receive regular treatment, this shouldn’t be an issue. Don’t feel pressured to exaggerate or embellish your medical care.  On a different note, investigators are also hunting for mental or nervous conditions or treatment by psychiatrists, psychologists, or therapists that can be used to shorten the benefit period.
  7. Daily activities. This is an area where open-ended questions may really hurt your claim. Training materials  specifically has investigators get claimants to describe, in detail, every activity during the day and the duration of the activity. Many investigators ask questions to which they aren’t entitled to answers, just to see if the claimant will respond. They will also ask questions about what you do “for fun,” like golfing or bowling. Investigator will also try to  obtain the names and contact information of anyone participated in these activities with you. Again, if you feel uncomfortable answering a question, ask the investigator to be more specific or fully describe the information they’re seeking. Often, they’ll acknowledge that the information isn’t required to be provided. Their open-ended questions are structured to leave room for the insurance company to make assumptions that usually favor the denial of your claim.
  8. Financial info.  Investigators may ask questions about the finances of you and others who resides in your household. Again, this is an area where you aren’t required to provide many of the answers they’re Outside of your personal tax returns, your self-employed business tax returns, and employer wage information, you’re not required to provide them with any other financial information. They may ask for breakdowns of monthly household expenses or how much your spouse earns on a monthly basis, but you are in no way required to provide this information – nor should you provide this information.  There are too many ways this information can be misused against you and your claim.

Investigations are one of the main ways an insurer gathers the information they need to delay or deny a claimant’s benefits. Knowing what types of questions they’ll ask and what information you’ll need to have ready allows for you to prepare in advance and not be caught off-guard when an investigator is sitting, smiling in your house. While not all of these categories may be broached during  every interview, it’s important to be ready for any question that may come your way. The insurance company investigator’s goal is to catch you unprepared and provide information that will harm your claim, even if it’s inaccurate. The fear and intimidation caused by having who are often former law enforcement interrogators in your home is a tactic insurance companies have come to use to get the results they want.

Training materials such as these are commonplace in the disability insurance industry and are road maps to getting the information claims examiners use to deny claims. Too many claim managers put on a good front for the public but circulate this information at industry conferences and behind closed doors. The countermeasures to these tactics is to be prepared.  If you’re worried about an upcoming interview with an insurance investigator or have any other questions about your disability claim, please call our offices toll-free at (855) 828-4100 or visit our website to sign up for a free consultation.

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