Dialing in surveillance – Don’t cookie cut your investigations
Combating Work Comp Fraud
Workers’ Compensation Fraud costs billions of dollars annually. Combating “work comp fraud” has vastly become a multi-billion-dollar industry for investigative agencies and investigators alike. That being said, we must keep in mind “what is the focus or focal point?”
I don’t want this to be a spin off on how to do investigations or surveillance, there are plenty of experts in our industry, each with their own way of doing things that net great results.
The objective here is not to lose focus on what we are trying to achieve and accomplish. We are combining forces, teaming up, forming partnerships, and alliances with adjusters, claims handlers, attorneys, insurances companies, TPA’s and many other entities to accomplish one goal… Combat Fraud!
Our industry is spinning into a world of metrics and calculated formulas on how fast a surveillance case must be worked, how many hours must be worked to make a profit, and how quick the invoice can get back out to the client. What happened to “due diligence”?
Too many times I see or hear about a suspected fraudulent claim that was referred out for “Surveillance”, but nothing was found, nothing was observed, and the investigator didn’t even know if the claimant was present. My first questions are always:
- What investigation was done prior to surveillance being assigned?
- What time of the day was surveillance conducted?
- What days of the week was surveillance conducted?
It amazes me when I hear no investigative work was conducted prior to surveillance being assigned. All 3 days were conducted on the weekday from 6:00 a.m. – 2:00 p.m.
So, I follow up with this coined phrase “You need to apply the S.T.O.P. process to all of your claims”.
We are all tasked with maintaining a budget. There is a wide array of services that can and should be conducted before we charge out, roll the dice with picking the right day of the week, and time of day that will net activity from surveillance.
Now that we have applied the S.T.O.P. process, let’s look at what services could be more beneficial before we allocate thousands of dollars to a surveillance. (Don’t get me wrong, surveillance is a great tool, and is a large portion of my company’s business. However, let the information/evidence drive and guide your surveillance, don’t let surveillance be the only option).
Let’s look at just a few tools available in the investigative world:
- Social Media Investigations – With pretty much the entire world being connected and hooked to the wild word of the web, social media platforms, sites and other community-based networks offer a ton of useful information. Now we can and have written books, articles, and briefs on just this portion alone. I am only going to skim the surface for time sensitivity purposes. Social Media Investigations can identify hobbies, past and future events a claimant may be involved with, and photos of activity or life style since the date of loss, or even reveal what the claimant, family and friends are saying about the injury or incident. This tool alone can help drive and point surveillance efforts to the right time, place, and date to initiate surveillance.
- Background Checks – Another great and valuable tool we have at our disposal. A background check can validate several things from civil and financial distress that may be a driving factor in this claim, civil litigations from medical collections that suggest ongoing health and medical issues, all the way to serious criminal history that diminish the claimant or witnesses’ creditability. Again, we can go on and on with the various types of information that are produced from a thorough background check, and these are just a few of the many.
- Medical Canvassing – This service is a fast growing, tremendous asset, that has just started to catch on in our industry. Even though it has been around for several years now, the true value and impact on claims has really gained momentum in the last year. Medical canvasses can reveal treatments just prior to the date of loss, identify a history of injury or related illnesses, identify unknown or withheld medical treatments, identify possible drug seeking behavior, and identify pre-existing injuries or illnesses. Medical Canvassing can assist all lines of insurance, attorneys, and HR professionals to include Workman’s Compensation, Auto Bodily Injury, Disability, and Liability Claims.
- Geographical Research – If surveillance is going to be a factor and utilized, you need to know the “layout of the land” what are the benefits and/or challenges to the location that the surveillance is to take place. For example, if the claimant lives on a rural, remote farm location, with multiple departure routes, is it going to be advantageous to send (1) one investigator from out of state in a sedan to sit out in the rural farm community? Again, here is where doing our “due diligence” comes into play. It is far more productive to do the geographical research of your area. Provide a solid action plan that points out and identifies the challenges, and gain approval for (2) investigators (maybe in trucks) than to run out, spend 2-3 days with one investigator with out of state plates on a sedan.
The above listed resources can be major factors in combatting and mitigating fraudulent claims. These are only a few of the services that should and can be the driving force behind a successful surveillance or investigation. By implementing these services in the beginning of your investigations, reviewing the identified facts, and compiling your action plan, you will see a difference in your results. Not every file will be fraud, but…