Triggering a Disability Claim Investigation

Recently, in commenting on one of our posts, a reader asked what type of "red flags" exist that may trigger a field investigation of a Social Security disability claim. While our experience in this area is largely in working for the special investigations unit of a long-term disability insurance company, it is likely the following are considered by the Social Security Administration as well, particularly when a denial of disability benefits is pending appeal:

• The claimant or insured is never home or unavailable when called.
• The use of a Post Office or private mailbox facility.
• Recent, unusual or extensive travel.
• Secrecy in shredding documents when garbage is “pulled.”
• Former co-workers or employers suggest outside activities.
• The claim is solely a mental/nervous condition.
• A lack of objective medical findings.
• A diagnosis of fybromyalgia or chronic fatigue.
• The claimant or insured has moved outside of the area.
• The use of leased or rented vehicles.
• A history of employment in a trade.
• The claimant or insured has been self-employed in an industry in which payment is typically made in cash.
• Failure to turn over “medicals” from non-supporting doctors.
• Frequent demands for benefits.
• A history of workers’ compensation claims.
• Competing medical opinions.
• Evidence suggesting malingering.
• Recent layoffs or downsizing by their employer when the claim was made.
• A disciplinary history at work.

While these are just some of the many “red flags” disability insurers look at, one should be aware of them, and always anticipate an investigation. Unfortunately, many of them can be reasonably justified or explained away. Nevertheless, disability insurers and the Social Security Administration will often use field investigations, even when unwarranted, as an excuse to delay paying out on a claim.