The insurance company representative assigned to your claim called you yesterday and left a message that they want to interview you. You couldn't sleep last night worrying your long term disability claim is about to be terminated. You are not sure if an interview is typical or not, but its sounds very threatening.
Don't worry, you should not necessarily be alarmed. An insurance company interview is a fairly common part of the claims process. Indeed, it happens with about 50% of the clients we represent. While typical, you need to be prepared to explain you disability prior to the interview.
Format of the Interview
The interview may be in person or by phone.
If you agree to do the interview in person, the representative may ask to come into your home.
If the interview is in person, the representative will observe your behavior and note any inconsistencies between your behavior and the alleged severity of your symptoms (e.g., your disability application says that you cannot sit for more than 10 minutes, but representative personally observes you sit through a 45-minute interview).
The insurance company’s representative will ask you a series of questions to get a better sense of whether you are disabled according to the terms of your policy.
The length of the interview is very difficult to predict. The length will depend heavily on the stage of your claim, the nature of your condition, the issues at hand, and the representative’s thoroughness. Typically, each interview lasts anywhere from 20 to 45 minutes. It may, however, last longer than an hour.
The insurance company’s representative may be very understanding and helpful, or extremely insensitive and aggressive – what you get is up to the luck of the draw.
Common Interview Topics
Whether your condition has changed
The representative will try to get a sense of whether your condition has improved, stayed the same, or worsened. Your claim may be at risk if the representative believes that your condition has significantly improved.
How you spend your day? (e.g., from the time that you get up, to the time that you go to bed)
The representative will try to get a sense of how your symptoms impact your daily activities. The representative may ask questions about everyday tasks, such as bathing, grooming, cooking, cleaning, shopping, and driving. Your claim may be at risk if the representative believes your activities are inconsistent with the reported severity of your symptoms.
The representative will try to get a sense of the nature, frequency, and severity of your current symptoms. Notably, the representative may not be aware of all your symptoms if he/she does not have your complete medical records, or if the records insufficiently document your symptoms.
Why you went out on disability (e.g., what changed from when you could work?)
The representative will inevitably wonder why you could work one day, but not the next. The representative will try to determine whether there was a triggering event that led to your disability. If your condition simply progressed over time, the insurer may press further as to whether you had another motive for going out on disability (e.g., desire for early retirement or fear that your job was in jeopardy).
Your hobbies and activities outside of the house
The representative may press you about your social activities, such as going out with friends, involvement in religious organizations, attendance at sporting events, or volunteer activities. Your claim may be at risk if the representative believes your activities are inconsistent with the reported severity of your symptoms.
Plans for the future, return to work, etc.
The representative may ask questions to determine whether you are motivated to improve your medical condition and return to work. If the representative believes that you have no desire to improve your condition and return to work, then the credibility of your claim may be damaged.
The insurance representative may probe to see whether you have traveled recently, or whether you have any plans to travel soon. Your claim may be at risk if the representative believes that your travel is inconsistent with the reported severity of your symptoms.
Estimate of how long you can perform certain activities
If applicable, the representative may question how long you can sit, stand, walk, etc. By asking these questions, the representative is trying to determine whether your activities are consistent with your doctor’s assessment, as well as the reported severity of your symptoms. This is usually a very difficult question to answer because symptoms and abilities may fluctuate in severity and frequency.
The representative may ask what types of treatment you have received and whether it has provided any improvement. The representative may also ask for a list of your treating providers. Notably, the representative may not be aware of all your treatment thus far if he/she does not have your complete medical records, or if the records insufficiently document your treatment. The representative may press you further if he/she thinks that you are not receiving appropriate treatment or that you are non-compliant.
The representative may ask about your current medications and any side-effects that you may experience. The representative is trying to get a sense of whether you are taking appropriate medications. The representative is also trying to get a sense of whether you experience any disabling side-effects, such as those notoriously associated with IVIG treatments.
How a Long Term Disability Attorney Can Help
A long term disability attorney can prepare you for the interview in a number of ways. First, an attorney can identify and address potential issues in your file that you are likely to be questioned about. Second, an attorney can show you how to frame your responses to highlight the most important parts of your claim. Third, an attorney be present to monitor the interview, object to any inappropriate questions, and ask necessary follow-up questions that the representative fails to pose.