Long Term Disability in the Context of Popular Social Media
Long term disability claims are often long and arduous by their very nature. As the benefits are subject to multiple qualifications and are paid out over an extended period of time, insurance companies and claimant disputes will often arise at numerous stages in the process. Claimants who have been injured and look to continue the benefits of their insurance plan need to be mindful of their condition and conduct even after being initially approved or risk being stripped of their benefits. This post explores one of the more controversial ways an insurance company may try to deny benefits: surveillance.
Long term disability is most often divided into two categories: ‘own occupation’ disability and ‘any occupation’ disability. Most insurance plans provide coverage for ‘own occupation’ disability for two years after a disability claim is granted. This category of disability allows for claimants to receive full benefits if they show that they cannot work at all in their regular job. This is known as ‘total disability’ in the insurance world.
Once two years have passed, the disability threshold changes to ‘any occupation’ disability. To continue full disability benefits, claimants must be totally disabled and cannot work any job. Claimants will need to provide medical information substantiating any claim for disability.
Given the expense of long term disability claims, insurance companies often look for ways to ensure that a claimant truly cannot perform the tasks of their own job or any other job. One method of doing so is through surveillance: a claimant may be observed by the insurance company to see if a claimant is doing something they claimed they could not do. If a claimant provides medical documentation saying she or he cannot run or walk for extended periods of time but is seen in participating in a marathon, the claimant may find their coverage promptly denied.
The Growth of Social Media
With the prominence of social media, physical surveillance is no longer strictly needed to monitor a claimant. Publicly posted pictures of the aforementioned marathon runner would be just as good as physical pictures taken by an investigator.
However, surveillance is not always fatal to a claimant’s claim. In Fernandes v Penncorp Life Insurance Company, 2014 ONCA 615, the Ontario Court of Appeal upheld the trial judge’s finding that despite surveillance evidence of the claimant perform actions that he claimed he could not do, it was insufficient in rebutting the significant amount of medical evidence that supported the claimant’s claim. The surveillance accounted for a small snippet of the claimant’s daily life which was insufficient in disproving the ongoing medical issues suffered by the claimant. In Fernandes, the insurance stopped paying benefits after reviewing the surveillance video and ignored the claimant’s medical information. For their actions, the court awarded an additional $500,000.00 in punitive damages and $25,000.00 damages for mental distress to the claimant.
Even taking Fernandes into account, it would be beneficial to be wary of photos put on to social media. It goes without saying that claimants should not lie to their insurers, however it is important to be mindful of the possible consequences of surveillance and prevent an unnecessary denial of benefits.
Contact Monkhouse Law today for a free phone consultation to inquire about a long term disability claim, whether you have been denied or foresee being denied.
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