What To Do If An Investigator Contacts You

Whether you have just filed a claim for disability, or you are already receiving an income, you may receive a request to meet with an investigator for a face-to-face interview. The purpose of the meeting is to determine if you are or continue to be disabled. Your rights with respect to an investigator, and what you should do to prepare for the meeting, are the same.

As a practical matter, you do not have a choice about meeting. You have to meet with the investigator. However, you do have a say about when and where you will meet, (preferably at a time and in a place that are mutually convenient) and whether you have someone with you.

It is advisable to prepare for the interview to increase your chances that the outcome will be in your favor.

Investigators only ask questions. While some may have had some minimal amount of training about medical conditions, investigators will not give you a physical examination.

It is advisable to not lie. That said, it is legal to frame your answers in a manner most likely to show that you are "disabled" and unable to work. It is up to you to prove that you are "disabled."

It is also advisable:

• To have the meeting in a place in which you feel comfortable. For instance, your home.
• To prepare for the meeting.
• To have someone with you.

How To Prepare For The Meeting

• Get your doctor involved. (To learn how, click here)
• Review the claim form.
• • The investigator is going to ask the same questions that were on the claim form. For instance: what keeps you from working? When did it start? When did you stop work? What were your symptoms? What are they now? Your answers should not conflict with what you said on the claims form. Be sure to add anything new going on since submitting the claim form.
• • Note the date you said your illness began.
  • Note the date when you became disabled. While in reality disability seldom happens on a particular day, it does for disability income purposes.
• • Note any symptoms that have shown up or intensified between the date you originally filed the claim and now. Just as you did on the claim form, it would be helpful to mention how each of those symptoms would negatively impact your ability to do the work in question.
  • Consider answering the same questions as if they were asked today. This exercise will help show you differences, which you can then point out to the investigator.
• If you are receiving an income due to a private disability income policy, check the terms of the policy under which you receive your income benefit.
• • What does it say about what condition you must be in to receive a benefit?
  • Does that change over time? For instance, a disability income policy could say that it will pay you an income if you can't perform your own job. It may go on to say that after a period of time (such as two years), it will only continue to pay if you cannot perform any job for which you are qualified. Consider the classic case of the surgeon who can't perform surgery, but can act as a doctor. If he had a permanent hand injury, he could not act as a surgeon, but can act as a doctor.
• Keep in mind that occasionally investigators try to rattle you by pointing out a contradiction between one of your statements and the doctor's or the employer's. No claim is perfect. Information from three different people is not likely to be identical. Differences happen. Don't be embarrassed about inconsistencies or contradictions and get defensive. If you get defensive investigators will tend to suspect you're hiding something, like your ability to work. Just explain your understanding of facts of the situation.
• Prepare for questions about your daily life. Questions generally include: How do you spend your time? How do chores like house cleaning, laundry, and shopping get done? How do you spend your time? - which may be phrased something like: Please describe a "typical day." Give the investigator the details, but keep in mind your "bad days" and don't focus on a "good day."
• Assume that everything you say will be recorded. If that makes you nervous, practice answering questions with a friend or family member in front of a recorder.
• Let your doctor know that you received a call from an investigator. Let him or her know that the investigator may also follow-up with the doctor. Ask if the doctor has any suggestions about information that would help show you are not able to work.
• While considering the above, please do not prepare so much that your responses will seem canned. Don't try to memorize your answers or prepare a speech. The key is to know what you want to say rather than how you say it.
• Expect to dress normally.
• If there are people otrher than your medical team who can attest to your inability to work, ask for a written statement to that effect - preferably signed in front of a notary. The statements or affidavits should support your continuing inability to do work on a regular and continuing basis. For samples see: Affidavits From Family, Friends and Co-Workers.
• Consider having a counselor or knowledgeable friend or acquaintance at the meeting, even if it's just to listen. The person can witness what was said should it become important later. He or she can also bring up symptoms and effects of symptoms that you may forget during the meeting.
• Consider recording the conversation with the investigator - after you ask the investigator's permission.
• Read Tips For When You Speak With A Person Investigating Whether You Continue To Be "Disabled"

If An Investigator Shows Up Unannounced

Investigators love to show up unannounced and unexpected, maybe hoping they will catch you doing something like re-roofing your house.

If you haven’t recently reviewed your disability file (including, as you’ll see below, your claim form and current situation) or the time when the person shows up is not convenient, request a meeting at a more convenient time that works for both of you.

Don’t refuse to meet with the investigator. If you’ve recently filed a claim, this will only slow down the claim and give the insurance company a reason to look harder for an excuse to deny your claim. If you’re already receiving an income benefit, not meeting may be cause to stop your disability payment.

Keep in mind that from the insurance company’s point of view, a meeting is another form of a request for information.

Let your doctor know you are being reviewed by an insurance company with respect to your continuing disability benefit.

Confirm that the doctor supports your claim that you are still disabled. Perhaps the doctor believes you can work if you receive an accommodation or receive some kind of help. If you're not familiar with the concept of an "accommodation" see Accommodation At Work.

Ask the doctor to write a medical report about your condition and how it continues to affect you. Ask the doctor to include:

• All your illnesses and injuries, including those that appeared after you filed your original claim for disability.
• Specific information about how your daily and work activities are affected by your symptoms and medications.
• A description of the drugs and/or treatments that are or have been used since the date (you filed your claim)(the last review) and that they have not significantly affected your ability to work.

Request a copy of your medical records for the period since you received you became disabled or since your last review - or for at least the last 12 months. Find out when the soonest you can receive the report and a copy of your medical records. If you can't get the medical report or medical records in time for your interview, ask that the date of the interview be postponed and tell the Representative why you're requesting the postponement.

Keep pushing the doctor for the report and medical record to submit as soon as you can. If you can't get them in time for the meeting, go ahead with the meeting and keep pushing the doctor to get this information as soon as possible.

If necessary, offer to pay for the doctor's time writing the letter. The doctor's time is not likely to be covered by your health insurance.

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

As you speak with an investigator, 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.

An investigator is not your friend.

Although the investigator may be quite pleasant, an investigator is not your friend. Instead, the investigator owes his or her living to the insurance company.

Get the investigator's business card.

Chances are the investigator is an independent contractor and not an employee of the insurance company. Either way, you want a record of the identity of the person with whom you talk.

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

Have a pad and pen with you for the interview. 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 seems questionable, noting the language used by the investigator as much as possible.

If you prefer, ask someone else to take notes for you, or, with the investigator's permission, record the conversation

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 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 will not rise or fall on the basis of one interview. Don't worry if you don't think it went well.