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Summary

Whether you are receiving a disability income from a government program such as Social Security, or a private program from either an insurer or an employer, the longer you are "disabled" and unable to work, the more likely there will be investigation to determine whether you are still disabled. Although it is uncertain when, or even if, there will be a disability review, it is advisable to prepare "just in case." 

The review could be as simple as a telephone call from a friendly voice. An investigator may call for an appointment. You may be asked to take a medical exam. You may even be subjected to secretive surveillance just like in the movies.

It is advisable to start now to be prepared for such contact. It will help remove the worry about whether you will be checked up on and say or do the wrong thing. It will also help you be in control. Preparation is easy. It involves a few steps such as continually reporting your symptoms and their affect on your ability to work to your doctor and  keeping a copy of your claim for and other paperwork in a safe place. (We provide a Symptoms Diary which can be useful for your meetings with your medical team as well as for disability purposes.)

If you are contacted by an investigator, it is advisable to prepare for the meeting. For instance, to review your original claims form. 

If your disability income is cut off, whether by Social Security or a private source, there are steps to take to try to get it started again and to protect other benefits.

For information about these subjects, see:

NOTE:

  • Keep in mind that insurance companies and employers have been known to use social networks such as Facebook and Twitter to learn whether a person who is receiving disability income continues to be "disabled." As an extreme example, it is difficult for a person who can't walk to say he or she continues to be unable to walk when there are photos posted on Facebook showing the person dancing or sky diving.
  • If the thought of dealing directly with an insurer is unnerving or provokes undue stress, consider giving a family member or friend a Power of Attorney For Finances and letting the insurer know to deal exclusively with that person. You will have to answer questions and possibly submit to a medical exam, but your agent will have the direct contact with the insurer.

Investigations By Social Security / Private Insurer and Employer Disability Plans

Social Security (Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)

As a general matter, the Social Security Administration will wait a few years from the award of disability status before conducting an evaluation determination. For example, reviews most often occur 3, 5 or 7 years after the award of the disability status.

However, if Social Security receives information that a beneficiary may have returned to work or appears to have improved, it will initiate a review.

Private Insurance Company Or Employee Plan

Insurance companies and employers generally do a detailed investigation before deciding to start making disability income payments. However, once the payments start to flow, there is generally very little checking about whether the person continues to be disabled so long as whatever requirements the insurer has are met. For instance, you may be required to file an annual report from a doctor that the disability continues.

If the disability is due to a mental condition, it is likely the company will start questioning whether the disability continues after a year or two.

There are some insurance companies or employers that may be more aggressive in their review of a continuing disability.

Disability policies provided by an employer

Some employers are beginning to conduct their own investigations to limit their costs. If you are covered through a group plan, it is worth asking about  your employer's procedures. There may be paperwork you have to fill out on a periodic basis.

What To Do If You Are Contacted To Prove That You Are Still "Disabled" For Purposes Of Disability Income.

If you should be contacted by an investigator for Social Security or an insurance carrier or even a former employer, keep in mind that:

  • Just like when you first applied for a disability income, it is up to you to prove that your disability continues.
  • The general rule is: "Cooperate - within reason." It is an easy tactic (particularly for an insurance company) to stop payment of your checks if it feels there is a lack of cooperation. You would then have to prove that you are due the money. While you do have to cooperate, you don't have to "roll over."
  • Your answers to an ongoing investigation should be consistent with the answers that prompted the income award in the first place. Pull out the forms and other documents you submitted when you first applied for disability income. That information becomes the starting point for any information to be supplied in a review.
  • If anyone calls you:
    • You can say that you would be happy to respond to any questions, but that you will have to call back to verify that the caller is indeed from the insurer. As you are likely aware, do not give any personal information to strangers who call. (To learn more, see Identity Theft.)
    • Once you have established that the call is legitimate, decide whether you want to talk on the phone or in person. It is recommended that you request an in person interview.
    • Either way, decide what is the best situation for you. For example, you may want to schedule a follow-up call or a person-to-person meeting for a time when a family member, friend or someone else can be there or listen on an extension or on a speaker.
    • If you aren't feeling well, postpone the interview until you are feeling better.
  • If someone shows up at your doorstep without an appointment:
    • First verify who the person is and his or her relationship to Social Security or a private payor.
    • Then explain that you would be happy to meet but that now is not a good time. For example, you can say that you're not feeling up to it or you have a doctor's appointment. It is not advisable to say that you have a tennis date or some other physically active event.
    • Set-up an appointment for when it is convenient to you and whomever else you wish to be present. If you would feel more comfortable meeting in another location (such at your social worker's office) set the meeting for there.
  • When you do speak with the investigator:
    • Get the investigator's name and telephone number.
    • Make note of the time, date and place of the interview.
    • Answer questions like you've seen witnesses do on T.V.: Stick to the answers to the question. Don't volunteer any information except when needed to clarify an answer.
  • The investigator will likely ask questions about your activities to find out whether you are in fact disabled.
    • Answer truthfully. Feel free to qualify answers about the activities you can do by saying something like: "When I feel up to it, I .…"
    • Keep in mind that your answers should indicate how your disability continues to interfere with your ability to work.
    • If you are receiving income from Social Security, Form SSA-454-BK is the form the representative will complete at the interview. It is strongly recommended that you complete the form prior to the interview to help you pull all your information together, make sure you don't leave anything out, and to make your answers consistent with each other. The form and advice for completing it can be found on our site at: SSA-454-BK.
  • If any questions make you feel uncomfortable, ask how the question is relevant to your claim. If you continue to feel uncomfortable in spite of the answer, ask that the question be put in writing, along with a written explanation for the reason that the question is being asked. Tell the investigator that you will respond in writing.
  • If the interview is in person, do not go overboard and try to look "disabled." At the same time, there is no need to try and "look your best" for any meeting either. Look how you always do.
  • If it makes you too uncomfortable to see someone in person, say that you will answer questions over the telephone or provide written responses.
  • If you are doing volunteer work, and that comes up in a review, communicate that you set the hours and the pace of the work. Distinguish your volunteer experience from work for wages. If applicable, explain how your bad days, or the side effects of your medications, or treatment schedules, etc. (which are unpredictable) interfere with a regular schedule. From the insurer's perspective, if you can show up on schedule and do regular tasks, you can do work for wages.
  • It is advisable to record the conversation or make notes of the questions you are asked and of your responses. Keep this record with your copy of your disability policy or other relevant file.

How To Handle Telephone Calls

If you receive a call from a representative of the insurer:

If the timing is not convenient, say so -- and request a call at a more convenient time.

Just because the timing is convenient for the caller, doesn't mean it's convenient for you. Even if it is convenient, you may want to take time to gather your thoughts and review the facts that could be relevant to the situation. You may even want to be able to

Assume that the call is being recorded.

The caller should tell you if the call is being recorded. Even if the caller assures you there is no recording, assume that you are indeed being recorded. The assumption will help keep you from saying things that you will later regret. 

Assume you are not talking with a friend. It is safer to assume that::

  • The insurer is seeking to cut its losses with respect to your claim.
  • That while the person may seem friendly and sympathetic, that his or her job is to find cause for stopping payments.

Of course, there are well meaning people who work for insurance companies, and there are companies that really do care about providing a service rather than just focusing on the bottom line - but if you make more cynical assumption you will be more likely to protect your ongoing income.

Don't downplay your symptoms - including to the general greeting: "How are you?"

As a general matter, when asked how we are, people tend to say something like: "I'm fine."  Instead, this is the phone call to unload your complaints.

Don't lose sight of the reason for the call.

Keep in mind that while an investigator will ask about your daily routine on disability, his or her real focus is on your ability to perform job related duties. Particularly keep this in mind when answering questions about how long you can stand, walk, sit, concentrate, or remember things.

It doesn't hurt to periodically relate a symptom to work, as in: "I can't even watch a movie on television without losing track of what's going on. No wonder, I had such trouble keeping track of inventory at work." Just be sure not to overdo it.

If you're asked about a "typical day:" Give the details. Keep in mind the bad days as well as the good ones. If a symptom impacts your daily life, be sure to tell the investigator how it impacts your life. For example:

  • If you eat cold cereal for breakfast because you don't have the energy to cook, don't just say you have cereal for breakfast. Say that you have cold cereal for breakfast and why.
  • If you take a lot of naps during the day because of fatigue which means that you can't do any projects that require long periods of concentration, or you're too depressed to read or focus on a movie, let the investigator know.

Occasionally investigators may try to rattle you with a contradiction between one of your statements and that of your doctor or employer. Don't fall for it. Information from three different people is not going to be identical. Differences happen, so don't be embarrassed about them or get defensive. If you do get defensive, an investigator may think you're hiding something.

Interviews with an investigator can be difficult. If you don't answer, or if you hesitate to answer a question, he or she might think you're hiding something.

Take notes or record the interview (with the investigator's consent).

Have a pad and pen handy. You don't have to write down everything that's said. However, it could ultimately be helpful to keep track of the types of questions asked.

Particularly make a note of anything that is said or asked that seems questionable, noting the language used by the investigator as much as possible.

Be assertive if necessary.

If an investigator asks inappropriate questions, such as questions that are too personal or irrelevant to the status of your disability, politely ask the reason for the questions. Usually the interviewer will back down. If he or she doesn't, you can say something like: "I am uncomfortable answering that question at the moment." Write down the question. Ask the investigator to send you a letter asking the question in writing with an explanation of its relevance.

Don't panic.

The claim or a continuation of your benefit is not likely to rise or fall because of one phone call. Don't worry if you don't think it went well. 

What To Do If You Learn There Are Surveillance Tapes Or Records

If the insurer conducts surveillance on your activities to determine if you are disabled, ask for a copy of the tape/video, a copy of all of the investigators notes and a copy of the investigator's report.

There is no reason to respond to any inquiry or assertion about what is in the video, notes or report until you see a copy and have a reasonable amount of time to review them.

If the investigator's activities cross the line and become harrassment, contact your local police department.




What To Do If Disability Income Payments Stop Or You Are Informed That They May Stop.

The answer depends on whether you are receiving income from Social Security Disability Insurance (SSDI) or a private disability income policy or plan.

Social Security Disability Insurance 

If your SSDI payments are discontinued for any reason, and you qualified for Medicare thanks to receiving SSDI payments, before you receive the last SSDI check, visit your Social Security office and tell your representative you want to continue your Medicare. Request the paperwork.

Once SSDI stops, you will have to start paying for Part A and B directly since A is no longer free, and there is no SSDI payment from which to deduct the premium for Part B.

Even if you get health insurance through an employer, consider keeping Medicare to fill in any potential gaps in coverage.

  • You will probably eliminate all fees, deductibles and co-pays.
  • You will reduce your overall medical bills to the more economical Medicare rate schedule rather than the higher rate schedule used by private insurance. This should decrease any part of the bills you pay.
  • Medicare has generous hospital coverage including psychiatric and substance abuse care, virtually unlimited medically necessary home health visits, and unlimited outpatient psychiatric care without the severe limitations imposed by most employer plans. Medicare also covers inpatient hospice care which many health plans don't cover at all.
  • You are always at risk of losing a job and its health insurance coverage. Medicare continues so long as you have your health condition whether you have a job or not.
  • If you are a federal employee, many of the federal employee plans "reward" you for signing up for Medicare by waiving deductibles and co-payments.

Private Income Plans

If your insurer informs you it is going to stop, or actually stops payments, think about whether you are still unable to work.

If you are not able to work, contact your lawyer, local office of a nonprofit organization relating to your health condition, or, in the case of a private carrier, your insurance broker for assistance.

If you feel comfortable representing yourself in a matter like this, speak with the supervisor in the area that makes the decision rather than the first person who answers the telephone. Explain why you continue to be disabled. Offer proof such as a letter from your doctor or affidavits from friends, relatives or other medical personnel who have enough first hand knowledge of your situation to be able to explain why you are unable to work.

If you have a good relationship with your former employer and the benefit is through the employer, consider whether the employer could use its clout with the insurer to help you.

If you get no satisfaction, call or write the president of the company.

If the situation seems totally unfair, contact the press. Survivorship A to Z tells you how to tell your story in a manner that makes it newsworthy. Click here.

If all else fails, contact your state Insurance Department: www. NAIC.org offsite link.