Once an individual qualifies to receive disability insurance benefits, they are expected to regularly update the insurance company on their condition by completing reports and by providing ongoing certification of their disability by one or more of their treating doctors.  But on occasion, some disability insurance companies also conduct field visits (aka, field interviews) with claimants to learn more about their activities, their progress in treatment, and sometimes to investigate suspected fraud.  

When a disability insurance claimant is contacted to participate in a field interview visit, there are some dos and don’ts we recommend.

Preparing for the Field Visit 

Insurance companies frequently ask whether their representative can meet with the claimant in their home.  There is nothing inherently objectionable about that; however, a neutral location such as a coffee shop, public library, or an attorney’s office is often a better idea.  Allowing the field representative into the claimant’s home invites comment about the state of the interior of the home and whether it appears well-maintained.  Also, it is natural to be hospitable to guests; and serving refreshments can result in a comment that may portray the claimant in a better light than is actually the case.

Thus, if the claimant has been represented by a disability attorney, it is recommended that arrangements to meet with the representative be coordinated by the attorney and that the attorney be present at the meeting.  If the claimant has not been represented by an attorney previously, it is a good idea to retain a disability insurance attorney if a request to conduct a field interview is made.

What to Expect in The Disability Insurance Field Interview?

Do not assume that the field visit is going to be hostile or that there is a need to be defensive.  Having that attitude could inadvertently create suspicion when there is none or heighten existing suspicion.  Field visits are not like depositions conducted during lawsuits – in most instances, the purpose is to obtain updated information and to encourage claimants to ask their own questions about their claims.

Claimants should dress casually and comfortably for the field visit; and it should be conducted in a setting where the claimant is physically comfortable.  It is typical that the field representative will ask to photograph the claimant, and the representative may also want to see the claimant’s driver’s license or other form of identification.  One reason for photographing the claimant is to better identify the individual if surveillance is conducted later; however, the usual use of the photograph is for the claim representative at the home office to be able to view the claimant as an individual rather than just a name on a file.  Sometimes, representatives want to record the field visit. There is nothing nefarious about such requests.

Claimants should be polite and should listen very carefully to the questions being asked and respond honestly and directly.  Misunderstanding a question could lead to an incorrect response.  An example we often give is of a field visit we attended with a claimant who had experienced a stroke that resulted in a significant cognitive impairment.  The claimant was asked whether he was able to pay household bills, and he offered a response in the affirmative.  The field representative then stated that meant the claimant could manage his household expenses.  We interrupted to advise the investigator that the claimant never said he could manage his household expenses and to ask that question directly if he deemed the information relevant.  When the question was subsequently asked, the claimant stated that he used to work in finance but was now unable to balance his checkbook  Problem averted.

Surveillance may have been conducted prior to the field visit; and the claimant may have been captured on video performing an activity such as walking their dog around the block or driving to a coffee shop or pharmacy. There may be inquiry about such activities; and denying performance of such activities when there may be video evidence to the contrary could turn out to be problematic. 

There is no reason why a field visit should last more than one hour.  Sometimes the insurance company or the field representative tells the claimant the visit will last at least 2-3 hours. There is no reason for that; and such requests are further justification for having an attorney present who can firmly but politely control the questioning. There is no reason for the claimant to be asked for detailed information about their education and work background when that information is already in the claim file.

How to Limit the Disability Insurer’s Excessive Requests for Documents and Other Material? 

Claimants should bring their medications (in the bottles) to the field visit.  It is standard procedure for field representatives to inquire about medications, and the easiest way to fulfill that request is to have the medications handy so the representative can write down as to each medication the name of the drug, the prescribing doctor, the dosage, and when the prescription was last filled.  Claimants should also bring a list of their treating doctors to the field visit containing the name, address, phone, fax number, and specialization of each doctor.  If there has been a very recent test or evaluation, it is also advisable to bring the test results of evaluation report to the field visit as well.

There may be questions asked that could be uncomfortable.  Social media is a huge target for disability insurers and claimants should review their social media postings before the field visit so they can explain any postings that might appear to be inconsistent with their claimed disability.  Claimants may also have records of business activities that could be brought up during the field visit. So long as such activities are not inconsistent with the claimed disability, they can be explained away.  Otherwise, the questions will typically follow the same template and focus on current medical treatment and daily activities.  

The Importance of Attorney Representation in the Field Visit

Disability insurance field interviews are not fun, and they can be inconvenient.  However, claimants should not be fearful of field visits and assume they are intended to trip up the claimant and become a “gotcha” moment for the insurance company.  Most of the field representatives we have encountered have been professional and efficient, and those who are perpetually suspicious usually do not last long.  

But we cannot emphasize enough how important it can be to have attorney representation at the field visit.  Although a claimant may have concern that an attorney’s presence will typically result in the claimant having to pay fees for the attorney’s attendance, having an experienced and knowledgeable attorney by their side fully justifies the expense.  The attorney’s role at a field visit is often like that of a referee at a sporting event but having someone present to call a foul or other infraction of the rules can head off avoidable problems and make it far more likely that benefits will continue.

Related Articles

Understanding Government and Church Plan Exceptions to ERISA

Understanding Government and Church Plan Exceptions to ERISA

The Employee Retirement Income Security Act (ERISA) is a landmark piece of legislation enacted in 1974 to safeguard the interests of employees who participate in retirement and health benefit plans offered by their employers. ERISA sets standards for these plans, ensuring transparency, fiduciary responsibility, and fairness in their administration. […]

ERISA 2023 Year in Review

ERISA 2023 Year in Review

Introduction The Employee Retirement Income Security Act of 1974 (ERISA) [1] directly impacts the lives of most Americans, yet few are familiar with ERISA despite its governance of pensions and retirement plans, along with other employer provided fringe benefits such...