When used appropriately, social media may sometimes prove to be a valuable tool to investigate personal injury and disability insurance claims. However, when an insurer improperly denies a claim for benefits based on an unjustified reliance on social media postings, the claimant may be able to turn the tables on the insurance company.
In Williamson v. Aetna Life Insurance Co., 2019 WL 1446957 (D. Nev., March 31, 2019), a federal court in Nevada took an insurance company to task for terminating a disability insurance claimant’s benefits without verifying the accuracy of information contained in the plaintiff’s social media postings.
Sondra Williamson worked as a customer service representative for Bank of America until she became disabled in 2012 as a result of severe cervical and lumbar degenerative disk disease. Aetna approved Williamson’s ensuing disability claim, but subsequently terminated her benefits after becoming aware of Facebook posts that showed her traveling and posing on a motorcycle.
Aetna also learned of Williamson’s posts on a dating-oriented social media site that implied an active lifestyle and current employment.
Williamson appealed the denial, and in her appeal, she explained the inaccuracy of her social media posts, some of which were reposts of activities from years earlier.
Aetna refused to rescind the denial, though, and litigation ensued, which resulted in a finding in Williamson’s favor.
With respect to Aetna’s reliance on social media, the court characterized such evidence as “an illogical, implausible and unreasonable basis for a revocation of disability benefits compared to the use of medical records.”
The court criticized Aetna’s actions in the face of its knowledge of “the inherent accuracy issues with such postings.” The court also pointed out that Aetna made no effort to verify the posted information and never inquired as to when the posted photographs were taken or “seek additional context.”
Most significantly, though, Aetna was found to have failed to “weigh this inherently inaccurate information against the medical opinion of plaintiff’s treating physician and the medical documentation of her disabilities.” The court added, “Social media postings are minimally informative and inherently inaccurate as to a person’s medical symptoms and capacity for sustained employment.”
Aetna also based its decision on surveillance obtained over the course of three days. On two of the days, Williamson never left her home and on the third day, a total of 11 minutes of video was obtained showing the plaintiff performing limited activities such as grocery shopping, which provoked the court to remark: “defendant did not observe plaintiff performing a recreational or optional activity that pushed the limits of her physical capacity; plaintiff was grocery shopping, an essential task that sometimes simply must be faced regardless of whether it exacerbates one’s pain.
“Finally, defendant completely disregarded the fact the surveillance also clearly indicated 71 hours of inactivity outside of the home by plaintiff. To put it in more stark but clarifying perspective, defendant observed 11 minutes of activity outside of the home compared to 4,309 minutes of inactivity – that is the outside activity represented 0.2 percent of the entire period.”
The court was also troubled by the absence of any evidence that Williamson’s condition improved following the approval of her benefits, observing: “While defendant is certainly not bound by its 2014 determination and need not overcome any substantial evidentiary burden to make a different determination in 2016, the court finds that defendant must at least show the objective medical reasons for changing its determination.
“It could have shown this in various ways, including pointing to new medical evidence that supports its 2016 determination or providing an objective review that explains that its 2014 determination was in error. The court reaches this conclusion because it finds that the objective medical evidence in the record supported defendant’s 2014 determination. defendant must therefore point to objective medical evidence to support the reversal or revision of its 2014 determination.
“In other words, there must be a reason, supported by medical evidence, for defendant’s decision to find plaintiff capable of performing a reasonable occupation in 2016 when she was not capable of doing so in 2014.”
Thus, the court ordered Williamson’s benefits reinstated.
This ruling does an excellent job of pointing out the limitations inherent in an insurer’s reliance on social media. The court implied that a burden should be placed on the insurer to verify the accuracy of the information before relying on it as the basis for terminating benefits.
The court also made it clear that such information, when contradicted by the medical evidence, is very weak proof that the claimant can perform at a higher exertional level. The court similarly put the surveillance in context and showed its limitations as reliable evidence.
While the court did not put an absolute burden on the insurer to demonstrate medical improvement between the approval and discontinuation of benefits, the court did require the insurer to point to evidence that the initial determination was erroneous or that the medical findings showed improvement.
Since Aetna could do neither, the court’s recognition of the utter poverty in Aetna’s decision-making resulted in a victory for the claimant.
This article was initially published in the Chicago Daily Law Bulletin.