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.