You and your insurance or fraud investigator disagree about the definition of a thorough or complete background investigation.
You want reassurance that you are only paying claims expenses that are truly warranted. You want to provide the payments and treatment required to return the claimant to his pre-injury or pre-illness condition. You know there is a lot of fraud and abuse in the system. You are aware of the “victimless crime” justification some have. You need sufficient evidence that the claimant is disabled or that he is abusing the system.
Your investigator wants to make the most amount of money at the lowest possible cost. Yet he also wants to build a relationship with you that will encourage you to use his services again. He does not want to admit that he does not fully understand what you need from this investigation. He must ensure he does not violate any privacy rights or laws in obtaining the evidence you need.
Despite what the media may suggest about privacy rights, there is more information available on all of us than ever. Technology has also improved the way we investigate claims. Tiny cameras can fit on lapels. Nearly every cell phone has a camera now, too. Gone are the days of conducting surveillance with large video cameras on car dashboards—or at least they should be.
When assigning surveillance and investigations to outside vendors, be specific about what you need to prove for your case. Are there inconsistencies with the history of the accident that photographs of the employer location might resolve? Do you need to show the claimant is working? Have you considered sending to your examining physician a videotape of activity inconsistent with the alleged disability? Could the claimant be operating an online business on eBay or elsewhere? What else is the claimant doing online? Are there hints to hobbies or interests that might suggest the time to videotape activity?
As I use it when I ask for it, “full investigation” is intended to mean:
- Background check
- Criminal records check
- Property ownership check
- Residence history
- License checks (e.g., driver’s, hunting, fishing, professional)
- Online presence search
- Anything else an investigator may have access to that I haven’t listed but may be useful to show the claimant is working, physically active, etc.
Your best investigators will have information under item “g” that you and I might not even know is possible!
Review the report as soon as you get it, and notify the investigator of anything that you believe was not fully investigated. Plan for a thorough investigation by giving specific direction. Take immediate action when the result is not as expected. Revise and repeat as necessary.
There is rarely any reasonable expectation of privacy in a public place. See Samuel D. Warren & Louis D. Brandeis, The Right to Privacy, 4 Harv. L. Rev. 193, 195 (1890).
NOTE: This post is a general overview of the how to use thorough investigations to defend (or mitigate damages in) WC claims. It is not legal advice, and there is certainly no guarantee that any of the actions detailed above will generate a similar or specific result. Past success is never a guarantee of a future outcome. If you require information or advice applied to your unique situation, please make an appointment to discuss it with an attorney. Don’t rely solely on what you read on the Internet.