WHEN TO USE SURVEILLANCE IN A WORKERS COMPENSATION CLAIM

Surveillance is one of the most common and powerful tools used to observe and document claimant activities when fraud is suspected. You should consider using video surveillance when the following condition(s) exist: 1. The claimant is out on time loss for extended periods; 2. Complaints are received from co-workers about the worker; 3. Your exposure to a claim is high; 4. The claimant needs an unusually lengthy time to recuperate; and, 5. There are rumors that the accident was not legitimate. At some point, you may want to consider a background check, possibly before the surveillance begins. These checks can sometimes reveal other causes of injury, such as a previous injury claim resulting from a vehicle accident (personal injury claim) or another incident not related to employment where the injury might not have occurred on the job. Red Flags do not automatically guarantee guilt but are basically indicators of potential fraud and so surveillance should be considered.

RED FLAGS!

• Timing of the claim - i.e., end of probationary period, the position is seasonal and the season is ending, or the worker is about to be fired, will retire soon, or is new to the job.
• Late reporting of the injury.
• Claimant does not seem interested in light duty when offered and/or suddenly seeks a new doctor when released back to work. Claimant does not show up for medical appointments or cancels them.
• Claimant calls you from a pay phone.
• Claimant treats with multiple physicians.
• Claimant’s disability is not substantiated by objective medical findings.
• Claimant is difficult or uncooperative during rehabilitation.
• Claimant refuses certain diagnostic procedures.
• Claimant is never home and/or moved out of state or the country after the claim.
• A “tip” is received that the claimant is employed elsewhere or is engaged in activities inconsistent with the injury.
• Claimant has financial difficulties.

What Can Be Done to Reduce Accidents and Injuries

• Institute hiring policies which ensure a worker is fit to do the job he or she is hired to do.
• Conduct regular employee safety training, dealing with the proper use of equipment and how to identify and deal with potential hazards. Stress the importance of the use of safety equipment.
• Display clearly written workplace safety and health guidelines.
• Introduce incentive programs which promote and reinforce workplace safety.
• Build a culture within your company where employees understand their rights and responsibilities regarding the Workers' Compensation System.
• Conduct an immediate and thorough accident investigation. Stay “in front” of your employee’s injury throughout the recovery process. Maintain continuous contact and show the employee your interest in his or her return to work.
• Stay in the “loop” of the claims process. Carefully monitor claims to ensure the system isn’t being abused.

REPORT SUSPECTED WORKER’S COMP FRAUD

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