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The stinking exercise that the private investigator did for the patient cost the insurance dearly

An insurance company denied an annuity to a nursing patient following an exercise conducted by a private investigator who impersonated a courier and photographed him going out to collect a package.

Following a lawsuit he filed, the payment was reimbursed in accordance with the policy and future payments were also approved for two additional policies related to the nursing policy.

All the details about the case

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• Insurance companies

• Private investigators

Adv. Aviad Klig, in collaboration with Zap Legal

Monday, 04 October 2021, 09:01 Updated: 09:08

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Private Investigator (Photo: ShutterStock)

It is known that insurance companies tend to employ private investigators to trap insured persons.

But sometimes the same investigators go one step too far, which can cost the insurance company dearly, and prevent it from using the findings of the private investigation against those insured.

This is exactly what happened to Lee, a nursing patient who had a severe stroke, which caused paralysis on the left side of his body.

Fortunately, Y. held not only a standard long-term care insurance policy of the HMO, but also two other long-term care insurance policies beyond that.

Y. first activated the standard nursing policy, contacted the insurance company and submitted the necessary documents, indicating that he was unable to perform a series of basic operations.

Shortly afterwards, a doctor was sent home who wrote an opinion confirming that Y. was actually entitled to payment under the nursing policy.

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The "courier from the post office" demanded to go out to collect a package

Y. began receiving a nursing allowance of about NIS 5,000 every month from the insurance company, but three months later was shocked when the insurance company informed him that the payment would be stopped.

The reason: an investigation conducted by the company which allegedly reveals that it is able to perform actions that do not comply with what is stated in the opinion.

Y. wondered what could be the reason for the strange message, and suddenly remembered an interrogation exercise performed on him, and until that moment he had not attached importance to it.

A few weeks earlier, he had been called by a man who had identified himself as a courier from the post office and said that he had an urgent package in his possession and that Shi must go out of his house himself to pick it up.

During the conversation that the "emissary" had with Y., Y. informed the emissary that his wife was not at home, but that the emissary nevertheless put pressure on him and frightened him that the package was urgent and that he must collect it now.

Following this, Y. eventually left the house with the treadmill, and was caught walking through the camera lens by the private investigator lurking nearby.

An exercise that must not be done according to the instructions and rulings

The ruling prohibits investigative practices that involve impersonation, and insurance companies are prohibited from conducting investigative actions that involve impersonation while intimidating policyholders.

Y. continued to look for the impostor messenger on the street, but of course it was not there, and Y.'s documentation on his feet (using a treadmill) soon made its way to the insurance company, which in turn hurried to deny him the benefit.

But the investigator should have known that the interrogation exercise he performed was invalid, according to the ruling and according to circulars of the Supervisor of Insurance.

The ruling prohibits investigative practices that involve impersonation, and insurance companies are prohibited from conducting investigative actions that involve impersonation while intimidating policyholders.

After the insurance company stopped paying the annuity to me, he filed a lawsuit through me in court.

The lawsuit alleges that the investigation was conducted in non-kosher ways, and that in fact the insurance company has no evidentiary basis that it could have revoked the policy.

In addition to returning the monthly benefit to Y., the court is also required to retroactively recognize the initial date on which the patient was recognized as a caregiver for the purpose of activating the two additional policies in Y.'s possession, which could only be activated after 3 years of nursing status. Which is no longer marketed).

It should be noted that the date of entry into force of the policies was of great importance in the proceedings, as these were unique policies that allowed for the payment of a lifetime annuity, in contrast to the standard policy that allowed payment for a limited period of five years.

Do not accept as "Torah from Sinai" findings of scholars

Following the lawsuit filed by Y., the insurance company filed a letter of defense on its behalf in which it denied what was attributed to it, and the judge referred the parties to mediation. In the end, the case was closed in a compromise, in which Y. received 80% of the value of his standard policy - a payment of about NIS 4,000 a month for five years.

In addition, his request to recognize the original date when he was recognized as a nurse was also accepted for the purpose of operating the additional policies - so that only a few months later he already started receiving the payments under those policies, which gave him significant financial respite and greatly eased his complicated situation.

And what are the key insights that emerge from the affair? First, that the insured are not allowed to receive as a Torah from Sinai investigative findings of private investigators, and they should know that this is not the end of a verse.

Second, each case should be examined according to its circumstances, and the right decisions should be made for it.

In this case, setting an early date from which to start counting the date of activation of the two additional policies was a strategic interest of the client, which was a key consideration in reaching a compromise with the insurance company.

The writer specializes in, among other things, claims for damages and insurance, and accompanied by many policyholders seeking to realize their rights with insurance companies

Tel: 077-2713378

courtesy of Zap legal

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