Field Form Mistakes, P4 - The Mistakes Made during a Field Interview That Can Ruin Your Long-Term Disability Claim

Welcome to Season 4, Episode 22 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "Field Form Mistakes, P4." 

Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, discusses the mistakes made during a field interview that can ruin your Long-Term Disability claim. Field interviews - where the disability carrier may send a representative in person to "interview" you about your disability claim - are common tactics used by disability carriers to ensnare or trap you. They are designed to be overwhelming, so policyholders make mistakes during the conversation that can be used to justify denying a claim. Today, host Nancy L. Cavey, will discuss more of the twenty-four common questions found in field interviews.

In this episode, we'll cover the following topics:

1 - Mistakes No. 19 - 21

2 - Mistakes No. 22 - 24

3 - Wow - Twenty-Four Mistakes

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Speaker A [00:00:15]:
 I'm Nancy Cavey, national ERISA and individual disability attorney. Welcome to winning isn't easy before we get started, I have to give you a legal disclaimer by saying that this podcast is not legal advice. The Florida Bar association tells me that I have to say that, so I've said it. But as you know, nothing is going to prevent me from giving you an easy to understand overview of the disability insurance world, the games the carriers play, and what you need to do to get the disability insurance benefits you deserve. So off we go now. Disability insurance companies are more than happy to collect your gold, and they have their own golden rule. It's not one that we've been commonly taught. They'll collect your gold.
 
 Speaker A [00:01:03]:
 And when you apply for your disability benefits, they may rule that you are not due your benefits or they may rule that we're done paying your benefits and terminate those benefits. As I've been talking about in the last three episodes, one of the most common tools a disability insurance carrier will use at all stages of a disability claim is the field interview. Now in my last episode, I talked about mistakes number 13 through 18 restrictions and limitations pushing and pooling mistake number 14 restrictions and limitations concentration mistake number 15 restrictions and limitations shopping mistake number 16 restrictions and limitations driving mistake number 17 restrictions and limitations computer skills and mistake number 18 restrictions and limitations hygiene now we are going to talk about the last type, the last six questions that are commonly asked in a field interview. Before we get started, let's take a quick break, so stay tuned.
 
 Speaker B [00:02:11]:
 Have you been robbed of your peace of mind from your disability insurance carrier? You owe it to yourself to get a copy of robbed of your peace of mind, which provides you with everything you need to know about the long term disability claim process, request your free copy of the book@kvlaw.com. today.
 
 Speaker A [00:02:30]:
 Welcome back to winning isn't easy. You ready? All right. Mistake number 19 restrictions and limitations your pain level look, if your physical condition causes pain that interferes with your ability to work, your disability carrier is going to be asking questions about your pain. These questions can include what is your current level of pain on a scale of one to ten? One being the least, ten being you're practically, you know, in the emergency room ready to undergo surgery. Number two, does your pain level vary? Number three, do you have good days and bad days? How often? Number four, where do you experience pain? Now there are some doctors who will have you complete a pain level scale diagram at every visit using that scale of one to ten. If you are going to fill out those forms. You need to do them accurately and not exaggerate. Now, the problem, I will be quite frank with you, is that your pain level number five might be my pain level number two.
 
 Speaker A [00:03:37]:
 So pain is not uniform. Every person experiences pain uniquely, and disability carriers don't understand that. And they will take that number scale and they will try to minimize your pain. Or alternatively, they'll say, you're exaggerating. Your pain level is not consistent with your examination findings. It's important, if you're asked questions about pain that you actually get your doctor's records and review them, particularly if you are filling out forms for your doctor and are asked to fill out a pain scale diagram because you want to be consistent. And of course, we also want to talk about ranges. That's another reason why I hate these questions, is because your pain level probably varies.
 
 Speaker A [00:04:22]:
 It probably varies depending on your activity level. It may vary based on the weather, it may vary based on the effectiveness of your medication. And I'm sure you have good days and bad days. So we want to talk about ranges, not absolutes. Mistake number 20. Restrictions and limitations your daily activity. Now, I'm sure that when you applied for your disability insurance benefits, you never thought you would have to explain what you do inside the house and outside the house. And you may be scratching your head saying, well, what does that have to do? Again, with my inability to do my own occupation or any occupation? Again, it's all about creating, either documenting or creating inconsistencies.
 
 Speaker A [00:05:10]:
 They're going to use your responses to potentially put you under surveillance to see if you're telling the truth. And by the way, their version of the truth doesn't always match up with reality. But I sure hope that your version of what you put in the activity of daily living form matches up with the surveillance. Now, in regard to your inside activities, you're going to be asked, do you cook, clean, use the microwave, laundry, dust, other household activities? I'm sure that you have difficulties doing these activities because of your pain limitation, emotion or other problems associated with your condition. You may have to break up these tasks. You may have to have someone help you. You may no longer cook meals. You may have to rely on the microwave.
 
 Speaker A [00:05:55]:
 Now, part of the problem with these questions is, you know, do you cook? Well, as I tell my clients, I think that's a very open ended question. Are you cooking for Thanksgiving for a family of 30, or are you putting something in the microwave? Are you cleaning the queen's castle? Or are you just using a cloth to wipe down the counter in your kitchen, are you doing the laundry for the bucks football team or are you just laundering a few pieces of clothing? So again, you can see that these are open ended questions that can result in traps for you. So you've got to distill these questions down to, to give precise answers. And of course, we've got ranges of activities, good days and bad days. Now, the bigger trap is going to be questions about activities outside of your home. Do you take out the garbage? Do you garden? Do you weed? Do you mow the lawn? Now what is gardening? I know that sounds strange, but in one case the person said, well, no, I don't garden. But they had surveillance of this person out in their yard over the course of a couple days, basically building a fountain. Now, that was stupid, quite frankly, but the carrier conflated that with gardening, with working in the yard, and basically went back to the doctor and said, I want you to look at this surveillance film.
 
 Speaker A [00:07:34]:
 I want you to tell me whether or not this person can work. And of course, the doctor was not impressed and said, of course the person could work, not understanding that this particular policyholder was breaking it up over the course of the day and would go in at the end of an hour or two, take their pain medication, put the heating pad on their back and paid for it because their wife wanted them to build this profound. So again, they're looking for inconsistencies. Can you do these kinds of things? Well, I hope that if you are doing them, your doctor knows about it, you're taking breaks. But quite frankly, I would prefer that you not do things like gardening or weeding or mowing the lawn. I don't necessarily have a problem with you taking out a garbage can so long as it's on wheels. But the other kind of activity, I think, is just asking for a claims denial mistake number 21. Restrictions, limitations, recreation, hobbies and social activities.
 
 Speaker A [00:08:46]:
 Now, I don't know why, but carriers view recreational activities, hobbies and social activities as the equivalent of working. They think if you can go on vacation, if you have a social life, if you can maintain a hobby, you can work. Now, I know that's not true. You may enjoy going out to take a walk, or you might walk your dog, or you actually might go out and golf. Depending on the nature of your medical condition, that might be okay on a limited basis. Now, I assure you that you're going to be asked questions about whether you went on vacation, where you went, how often you went. And that can be a problem because I quite frankly, don't like people to post, as I've said before, pictures on the Internet of what it is they've done. Because, again, that's curated reality.
 
 Speaker A [00:09:45]:
 But if you are going on some sort of a vacation or a family event, I think that you would consider documenting. Did the location of your travel change because of your disability? If you flew, did you have to get up, move around? Did you have to have a wheelchair at the airport? When you went to Disney, were you using a wheelchair? Did you just stay an hour or two and you went back to the hotel? If you went on a cruise, did you not do all the island excursions? Or, you know, did you spend all the time in your cabin? So those are the kinds of things that you need to, again, think about to be able to explain why you did what you did, how you did what you did, how you may have paid the price for what you did. Because you can assure, be assured that the disability carrier is going to take whatever you're doing and run with it. Am I saying don't do it? No, I'm saying go ahead and do it. So long as you are taking the necessary precautions to protect yourself by documenting in your activity of daily living form what you did, the problems you had, the price that you paid, and that you also let your doctor know that because you want, you don't want your doctor to be surprised to find out that you went to cancun on a vacation and have them draw the wrong conclusion. Okay. All right. Let's take a quick break before we go over the last three mistakes that you can make in your activity of daily living form.
 
 Speaker A [00:12:00]:
 Welcome back to winning isn't easy. Let's finish this puppy. All right. Mistake number 22, lawsuits or disciplinary action. Now, if you are a professional, you can be assured that you are. They're going to ask you questions about whether or not you've had any disciplinary actions, and they will do an investigation of your background. They want to see if you've had any kind of disciplinary actions that would impact your ability to practice. Now, many times a disability carrier will argue that your disability is associated with your disciplinary issues.
 
 Speaker A [00:12:35]:
 In other words, you can't work because you have licensure issues. Now, they also may argue that you're having personnel issues with your employer. They'll argue that you're a disgruntled employee who's decided to file a disability claim because of personal or personnel issues or professional issues. They also are going to get a copy of your personnel file from your employer, and they're entitled to it. You need to be truthful about any disciplinary action and any lawsuits. I can assure you that they're also going to do a records search. There's an index service that can be used to determine whether or not you have filed any kinds of lawsuits, in fact, even whether you've had an I auto accident, a worker's compensation claim, a slip and fall. Here in the southeast, it's called the Southeastern Index, and it is used by disability carriers to determine if you've been involved in any kind of accident or injury or lawsuit.
 
 Speaker A [00:13:38]:
 They also will do a civil and criminal check in the area that you live. So they will be looking for criminal activity, arrests, DWis. They'll be looking for lawsuits, including divorce lawsuits. That can be crucial because there's nothing worse than a disgruntled former spouse who wants revenge and will be more than happy to torpedo your disability claim. So you need to be truthful about that. But you also need to be cognizant that that can come back potentially and bite you. So you need to make sure that, again, you are truthful. Because if you're not truthful, they're going to jump all over that and they're going to use that as a weapon.
 
 Speaker A [00:14:29]:
 And, of course, if any of that is relevant to your ongoing medical condition, you need to be truthful with your doctor. So if you've been involved in a prior auto accident and had a herniated disc, had surgery, but recovered and went back to work, then the doctor should know that and certainly should know why you are now claiming you're disabled. Have you had a new accident or injury? Has your condition gotten worse? If so, how has it gotten worse? So remember, you need to be clear about that. Now, just as an aside, I know that information about disciplinary actions can be confidential, and I want you to make sure that you're not violating the confidentiality requirements by giving the disability carrier more information than you are legally allowed to disclose. And if that is the situation, I would be consulting with anybody who had represented you earlier in any disciplinary action to get their legal advice as to what it is. If anything, you should be disclosing mistake number 23, work accommodations. Now, you may still be working or disabled, and you're going to be asked whether or not there have been any accommodations made by you or your employer. Are you working from home? Have your hours been reduced? Do you have any special equipment? Are there changes that can't be made to help you do your work? Do you have good days and bad days? Can you do a sustained activity with these accommodations, or do you have to pace yourself.
 
 Speaker A [00:16:01]:
 Now, all of these are important, and part of this ties back to what's in your disability policy, because sometimes there are disability policies that will evaluate your disability based on whether or not accommodations have been made or could be made. And you need to know that before you stop working and apply for your benefits. If there are accommodations being made, you need to be able to document what they are, how the accommodations are impacting your ability to work, and the fact that you are still having ongoing problems. And in fact, you may want to be documenting them in your personnel file or any reports to your employer as appropriate. And again, you want to keep copies of these emails, particularly as it relates to accommodations, because ultimately there might be an issue in terms of accommodations that could rise to employment law claims, which can in part be inconsistent with a disability insurance claims. And if that happens and you are consulting with an employment lawyer and you're considering applying for disability, that certainly is the time where you definitely also want to have a disability attorney and have both attorneys be consulting with each other because, as I said, there can be some inconsistencies between claims for failure to accommodate and discrimination and a disability insurance claim. And so we want to be coordinating all of that with the employment lawyer so we're not filing contradictory claims. Mistake number 24, personal and financial information.
 
 Speaker A [00:17:40]:
 Now they're going to be topics. One of the topics is going to be your education. What's your highest level of education? When did you get that? Why? Because when the definition of disability changes from own occupation to any occupation, they're going to have their vocational evaluator look at your education and determine whether or not you have any skills that would transfer to other occupations based on your education. They're going to ask questions about finances and that can include such as things as workers compensation. Are you getting workers comp benefits? Are you getting any other settlements or payments as a result of an automobile accident? Why? Because one, they want to get all the medical records, and two, they have the ability to offset or reduce your benefits by the receipt of that income. Are you getting disability income from any other source? In other words, do you have another disability insurance policy now? You might, and it's really crucial that you have all your disability insurance policies because some of these policies will say, we won't pay you benefits if you're getting disability benefits from another carrier. Whoa, you didn't know that, did you? But you need to know that again before you stop work and apply for benefits. And that can be problematic because, by the way, both disability carriers might also have the right to offset not only the benefits you're getting from them, but Social Security benefits or other income that you're getting.
 
 Speaker A [00:19:10]:
 So there could be a double whammy. Offset business income. I represent a lot of doctors, lawyers, CEO's, CFO's, and I will tell you, business income is an issue. Have you received any income from any company, store, person, business, self employed business? That includes money, barter or remuneration? Do you have an interest or income in any business? Let me tell you how that torpedoed case involving a Wells Fargo highly paid executive. He made almost a half a million dollars a year, and he claimed that he was disabled and unable to work. He disclosed on his ADL form that he was trading, I think, sports cards on eBay. Well, guess what? He didn't tell them. He and a partner had started to invest in a sports complex in the tri state New Jersey area.
 
 Speaker A [00:20:03]:
 They actually bought 22 acres. They hired people to help set up this training facility for baseball and soccer. They took out, I think $11.5 million million dollar loan. And worse yet, this policyholder was with his lawyer at three zoning hearings on rezoning the land that they bought. And the carrier got the videotape of the zoning hearings. And this guy didn't move at all during the course of these hearings. And he alleged he had a back injury. Well, of course they discovered all of this when they did their licensure check.
 
 Speaker A [00:20:51]:
 They did a property real estate check, they did a corporation check, and guess what? Not only did it come back to bite them, his claim was denied. It went to federal court. The judge said, really? You lied on your activity of daily living form? Why should anybody believe anything you have to say? And worse yet, because this was in New Jersey, I'm pretty darn sure that this case got referred to the Department of insurance fraud unit. And I will tell you, in New Jersey, they are pretty aggressive about insurance fraud. So you can see that there are consequences here. They're going to ask questions about pension, did you receive any pension or any other type of retirement benefits? Why offsets. We talked about Social Security offsets. And as I've explained before, you need to understand that there are indexes in the United States.
 
 Speaker A [00:21:50]:
 These index keep track of every other claim you might have filed. If you've been in an accident, auto accident, slip and fall, workers compensation filed any kind of claim, they can find it, and they will. And they're going to use it to argue, one, that you're lying, that you're fraudulent, you're not believable your doctor's opinions are not believable because you lie about this and you lie about everything else. And ultimately they can suggest that you are committing fraud. Now this also can be an issue that arises if you have what's called a residual disability claim. So you're entitled to benefits, you're losing income, you're a professional, you're not making as much, and you are filing monthly residual disability claims. You need to understand what the term business income means because that can destroy your claim. I've seen claims destroyed because the applicant didn't know what they were entitled to in terms of their long term disability benefits and the residual calculation.
 
 Speaker A [00:22:55]:
 There are I'm involved in a case right now where one policy is defining business income as income that is received in the month in which you're claiming benefits. I have another the other policy talks about we don't care when you got paid, we want to know when the service was performed. Now, two different policies, same professional, same disability. But the method of calculation is different and we want to make sure that we understand the definition of business income and that we are reporting it accurately. You can see again, lots of traps in these activity of daily living forms. So let's take a break before we close out this mini series, all right?
 
 Speaker B [00:23:44]:
 Are you a professional with questions about your individual disability policy? You need the disability insurance claim survival guide for professionals. This book gives you a comprehensive understanding of your disability policy with tips and to dos regarding your disability application that will assist you in submitting a winning disability application. This is one you won't want to miss. For the next 24 hours, we are giving away free copies of the disability insurance claims survival guide for professionals. Order yours today at disability claims for professionals.com.
 
 Speaker A [00:24:41]:
 Welcome back to winning isn't easy. We have covered 24 mistakes. Any one of these mistakes can doom your claim and that can result in a denial or termination of your benefits. Again, you have to take these activity of daily living forms seriously, but realize that they are open ended questions that are written in a way designed to trap you, to make you exaggerate what it is you can and cannot do. The way to handle this, obviously, in my view, is to have an experienced, arrested disability attorney working with you to make sure that what you're putting on these forms is consistent with what's in your medical records and I regularly take a red pen to them and edit them. It's also important that you need to explain things in terms of ranges, good days, bad days, and don't lock yourself into absolutes. If you are being scheduled for a social for a field visit. It's not a social visit.
 
 Speaker A [00:25:43]:
 It's a situation where they don't really care how you're doing. They don't really care the pain that you're in. They don't really care what financial difficulties you're having or they're causing you to have. They're interested in setting a trap and having you walk in that trap, spring it and say, aha, we've got you. And sometimes I have seen people, field investigators, come to a home and reach conclusions about your ability to work based on how clean your home is or how tidy your yard is. Worse yet, I've seen cases where the field investigator comes to the home, takes the statement, and then springs the surveillance on the applicant or policyholder and says, Gotcha. And then ask them to sign a statement that says they haven't been telling the truth. Oh, come on.
 
 Speaker A [00:26:33]:
 Really? Again? You should be seeking out advice from an experienced long term disability attorney to help you avoid the minefields when the carrier is asking you to fill out activity of daily living forms and or are scheduling you for a field statement. In the words of one of my children's favorite tv characters, Danger, Will Robinson. Danger, will Robinson. You are in danger of having your benefits denied or terminated. My firm can help you prepare for your statement and your field visit. You can contact us@www.kvlaw.com or call us today at 727-894-3188 for a complimentary consultation. Now if you've liked this podcast, please consider liking our page, leaving a review, or sharing it with your friends and family. Remember, this podcast comes out weekly, so stay tuned next week for another insightful episode of winning isn't easy.
 
 Speaker A [00:27:31]:
 I hope you've enjoyed and learned lots in this four part episode about activities of daily living forms and the traps and tools that disability carriers will use to delay, deny or terminate your benefits.