Surveillance Failed. What a Bummer, Or Is It?

Investigative surveillance is a time-tested technique for gaining clearer insight as to whether the injury complaints and limitations claimed by an injured worker are a true depiction of their actual condition. Compared against the claims to their doctors or what they testified to in a deposition, surveillance can better inform Claims Examiners and the worker’s physicians as to whether the injured worker is being truthful in what they are saying they can and cannot do. Surveillance is not appropriate in every case, but often provides great value in those cases where the worker’s claim has been called into question based upon identified red flags.

If surveillance is “positive”, meaning that the worker is captured on video performing in a physical manner which appears to clearly be inconsistent with what they are telling their physicians that they are capable of, ICW Group’s Special Investigations Unit is likely to start to determine whether sufficient evidence exists to refer the case to law enforcement for further investigation and ultimately prosecution consideration.

Surveillance is not always successful. In addition to the inherent challenges of discretely capturing on video the physical actions of a person who may or may not have planned to engage in physical activity that day, or the possibility of losing a car in traffic or a person in a busy crowd, there is also the possibility that the worker is seen to display the physical limitations that are consistent with their reports to their doctors. The video showed them injured. Is this a failure? Was the effort doing surveillance a waste? Absolutely not. The purpose of surveillance is to determine the truth. If the truth is that the injury is lasting much longer than would be expected, or more limiting than what is the norm, confirming this to be the case is very valuable. While it is always possible that workers may fake their injury when out in public, this is a tough act to keep up. Surveillance will typically cover multiple days for this reason.

If surveillance comes back as negative, meaning suspicions were not supported, this is not a bad thing. Surveillance was in fact effective. The weight of concern which employers shoulder about an employee attempting to defraud them, their insurance carrier, and the workers’ compensation system can be a lot. The sooner the truth can be discovered, the better for all.

ICW Group’s Special Investigations Unit serves as an additional fact finding resource for ICW Group’s Claims Department. If the facts suggest that the worker is as injured as they say they are, great! If, however, the evidence indicates otherwise, the case will then shift into a different mode wherein the elements of fraud need to be established so that law enforcement can make an informed prosecution decision.

Investigative surveillance is a time-tested technique for gaining clearer insight as to whether the injury complaints and limitations claimed by an injured worker are a true depiction of their actual condition. In partnership, let’s uncover those facts. If you become aware of an injured worker participating in undisclosed secondary employment, physical activities clearly outside of their restrictions, or similar activities that may help to better inform us in the handling of the claim, immediately notify your Claims Examiner so that investigative surveillance may be considered.

Christopher Dill
Christopher Dill
Christopher Dill is the Special Investigations Unit Director at ICW Group Insurance Company. A Fraud Claims Law Specialist designee, he was a recipient of the National Health Care Anti-Fraud Association’s Investigation of the Year Award for his significant contribution to the successful resolution of “Operation Back Lash” – one of the largest workers’ compensation health care bribery schemes ever uncovered in San Diego County. Christopher has participated in over 30 criminal cases surrounding medical and legal providers attempting to defraud the Workers’ Compensation system. Christopher’s approach to insurance fraud investigations is a holistic one. From preventative education campaigns, to data analytics, to time tested investigative, and intelligence gathering techniques, it is Christopher’s belief that a multi-faceted approach to insurance fraud is necessary to a successful defense.

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