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Insurer’s Reliance Upon Surveillance Improper, Appeals Court Holds

Tuesday, February 24th, 2009

One of the common investigative tools utilized by insurance companies in an effort to terminate long term disability claims is surveillance, whereby the insurer seeks to observe a claimant and capture activity which it determines is inconsistent with the claimed limitations of an insured.

A recent case from the Fifth Circuit Court of Appeals (Texas) has upheld a lower court’s determination that the insurance company’s reliance upon surveillance constituted an abuse of discretion.  The Court held that the surveillance was generally consistent with the claimant’s alleged limitations and did not adequately address the ability to perform the duties of the claimant’s occupation.  Citing other cases, the Court held that the insurer unfairly equated the insured’s known abilities with the more strenuous duties of her occupation, reflecting a plain lack of objectivity in its review.  Bray v. Fort Dearborn Life Insurance Co.

Many insureds’ claims are terminated due to surveillance.  If your claim is terminated due to surveillance or other investigative tools, it is imperative that you seek out counsel during the administrative appeal process, to secure and protect your rights and develop powerful arguments that will help you succeed on your claim.

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