Home » Insurance Investigations » Disability Insurance Investigations
In the realm of insurance and disability claims, investigations into malingering and undisclosed pre-existing conditions are crucial for maintaining the integrity of benefits systems:
Malingering: This involves scrutinizing claims where individuals might be falsely representing or exaggerating disabilities to obtain insurance pay outs or other benefits. Investigators use various techniques, including surveillance, review of medical records, and specialist consultations, to determine if the severity of the claimed disability is consistent with observed behaviours and medical evaluations.
Pre-existing Conditions: Insurance companies often need to verify whether a claimant has undisclosed medical conditions that predate their current claim. This process involves a thorough review of the claimants past medical records and may include discussions with previous healthcare providers to ascertain the onset and awareness of the condition. Ensuring that conditions were not previously known and undisclosed helps in determining the legitimacy of a claim and whether it is covered under the terms of an insurance policy.
Both types of investigations are designed to prevent fraudulent claims, ensuring that only those genuinely in need receive support and benefits.
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Subjects medical records can only be reviewed with written permission of the client or through a subject access request (SAR) by the client.
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