Workers’ compensation payers who utilize surveillance or investigators are nothing new to comp, many think it’s a good idea to make sure payers are not paying out for things they don’t need to. What is a recent development is that investigators are able to use social media in their efforts to track down claimants who are not telling the truth about their injuries. In many cases we’ve reported on WCInsights that method seems to be working out very well.

Payers tend to use surveillance or investigative services only if they have a strong reason to suspect a worker is exaggerating about their symptoms, they don’t do this to every single claimant. Less than a tenth of workers’ comp cases are candidates for surveillance. The investigators look at videos, social media accounts or other documents that can lead to smaller settlements or in some cases an overturning of benefits. They can also show evidence to doctors who have placed work restrictions on a patient in an effort to get those doctors to change their opinion.

Debra Levy works at York Risk Services Group Inc. and said that since the costs of investigations are so high they need to be sure they are going off a good tip and not just conducting these for no reason. Most investigations last a minimum of two days to make sure they are seeing a consistent or repetitive pattern that would give good enough evidence that the injured worker is lying about their abilities.

Investigators do not invade privacy, they track claimants when they are out and about or they look at their activity on social media. Anything that a public person could see is evidence that the injured worker may not be truthful.

There are a couple indicators that adjusters or claims handlers can spot in a claim that could tip them off that it might be a fraudulent claim and require investigation. If a claim is reported on a Monday morning (sometimes workers may be injured over the weekend and try to pass it off as a work comp claim), if there are no witnesses to the incident to support their story, or if they report the claim well after the accident happened, it may be worth a look into.

That’s not to say employees are the only ones who commit fraud. Employers who misclassify their workers are committing fraud. Providers who perform and bill for unnecessary procedures may be committing fraud. There is a lot going on behind the scenes in businesses and corporations that can be fraudulent too so let’s not lay all the blame on workers, but these are some things to keep in mind if you suspect that an injured worker’s claim could be untruthful.