Contributed by Poirier Law Firm
Surveillance technology has long been used by insurance companies to dispute worker’s compensation claims. An employee is videotaped or photographed in public view, doing something that “appears” to be outside their restrictions. And as technology continues to evolve at a rapid pace, insurance companies keep trying to find new and better ways to help establish fraudulent activity. This is unfortunate for the many who have honest work-related injuries, as they are placed under a microscope just like those committing fraud. Furthermore, even while the investigators are using techniques within the constraints of the law, the evidence is often taken out of context and misconstrued during court. With insurance companies using everything from predictive analytics to saliva testing, there seems to be no end to the lengths investigators will go. Here are some of the way insurance companies are leveraging technology to investigate workers comp claims.
Wearable technology refers to tiny digital devices attached to the body that can collect a variety of data, including exercise, eating, driving, and other habitual activities. The data is then communicated to a third party, such as an insurance company. Apple Watch and Fitbit are examples of wearable technology which can track movement down to the last step. Insurance companies investigating fraud utilize this technology by comparing the claimants reported movement capability with what the technology recorded as actual physical movement. To illustrate let’s say Jane Smith reports she can’t walk over 3 minutes without having to stop for a period. But the Fitbit monitor is recording 30 minutes of nonstop physical activity at a time. Jane would have the uphill battle of trying to explain the discrepancy against nearly infallible technology.
There are privacy concerns related to a wearable device and many say they pose a health risk. Workers report experiencing headaches, dizziness, and double vision while using the technology.
Investigators are leveraging technology to capture, access, and analyze claims data as early as possible. Automated technology examines every new claim and refers it on if fraud is detected. Predictive modeling helps identify fraudulent claims quickly and accurately by looking at thousands of variables simultaneously and recognizing complex, hard to detect but relatable patterns. For example, the modeling may indicate that a claimant is linked to more than one social security number, several different home addresses, multiple birthdates, etc. which would score high on the fraud scale.
Monitoring social media is a growing surveillance tactic for insurance companies wishing to investigate potential fraud. With statistics indicating 81% of the US population has a social media profile, the chances of a claimant using their profile is all the cause an investigator needs. Facebook, Twitter, Yelp, YouTube, Snapchat, etc. can be accessed and searched if they are publicly posted. Investigators may not participate in misleading tactics to gain information. An example of a misleading tactic is an investigator “friending’ a claimant to get private information. But if the claimant boasts on her Facebook page she is double dipping by working another job even though she is still collecting disability for a work-related injury—the information is fair game.
Much of the time what happens is an employee receiving compensation payments will get caught at a party or some social event where their photo gets subsequently posted to a social media site. Investigators also receive information from people connected to the claimant and can secure images, links, video, and potential witnesses. Social media is replacing traditional surveillance techniques and yielding better results at little to no cost. Insurance companies love it as a tool because there is no risk of being detected “snooping”, it’s affordable, and it’s efficient.
There is a new test available that can help provide 90% accurate prognosis for concussions in children, and will soon be available for adults. Essentially, genetic material is collected from the saliva which indicate if the symptoms of the concussion will last at least one month. Symptoms of a concussion include headaches, fatigue, and difficulty concentrating and often interfere with a person’s daily routine. The legal implications of the saliva-based brain injury test are this is considered objective evidence even when other traditional tests—like an MRI—have a negative result.
There is undoubtedly a huge problem in the US with workers compensation. The U.S. Bureau of Labor Statistics reported employer costs for employee compensation averaged $35.64 per hour worked in September 2017. That is a staggering number. But people with genuine work-related injuries should not be penalized for those individuals who commit fraud. As an injured worker, understanding the different surveillance options is a way to prepare and protect yourself. You don’t want to give investigators anything that they could use that would be taken out of context in front of a judge. The fact is, the best you can do is be honest from the start and be smart about your activities—it’s your best chance at getting the compensation you deserve.