March 2016

 March 8, 2016

Surveillance Do’s and Don'ts

If you suspect a workers’ compensation claimant might be malingering or working while disabled, contact your claims adjuster with any evidence you might have. He or she will then likely contact the claimant’s treating physician to get additional information on the claimant’s condition and any physical limitations imposed by the injury. If those inquiries are inconclusive, he or she might bring in an insurance investigator.

Investigators often do surveillance work. For example, in the case of a fraudulent workers’ compensation claim, an investigator may covertly watch the claimant to see if he or she does activities that would be ruled out by injuries stated in the claim. Due to its cost, calling in an investigator is often the last resort on an expensive claim. It also can create privacy concerns if not handled appropriately.

Surveillance Do’s and Don'ts

1.Use a licensed investigator with experience in workers’ compensation claims. A licensed investigator will know how to conduct an investigation without violating the employee’s privacy rights.

 2.Be clear what you want the investigation to determine. In most instances, for a workers’ compensation claim you would want the private investigator to determine whether a worker is doing work for pay while supposedly disabled, or doing activities that would be proscribed by his/her condition, such as playing golf while out of work with a slipped disk.

3.Determine your budget up front. Surveillance can be time-consuming and costs can quickly add up. Weigh the cost of the claim with the likelihood of finding usable evidence of fraud in determining how much you want to spend.

An experienced claims adjuster can help guide you through the process. For more information on handling workers’ compensation claims, please contact the PCOC Insurance Program department of EPIC at (877) 860-7378 or, email us @ ProPest@epicbrokers.com. Also check out:www.pcocinsurance.com.