Avoid Ethical and Legal Pitfalls In Workers’ Comp Surveillance

Surveillance can be an effective tool to reduce costs in a workers’ compensation program. While many service providers can show “injured” employees doing some crazy activities, it comes with a price and often does not produce the desired results. Before hiring a service provider to engage in surveillance activities, claims handlers and their managers should understand how to use it in an effective manner.

Use of Surveillance in the Right Case

The sheer volume of workers’ compensation claims coupled with the cost of surveillance limits the amount of cases that can use this discovery tool. A proactive claims management team must set parameters on when it is to be used and for the length of time to conduct surveillance on a suspect employee following a work injury. Cases that are prime for using surveillance often include:

• Cases where the claimant is likely to or has made a claim for permanent total disability cases. It is understood that these are the cases with the most exposure. This can also include catastrophic work injuries and their resulting complex claims;

• Instances where you receive a report of possible fraud or other information the employee may be engaging in suspicious activity that exceeds their stated limitations or abilities. Tips should obviously be carefully vetted. This is especially the case where the tip is anonymous. Always consider the source; and

• Instances where the information being reported by the employee does not coincide with verifiable information.

Avoiding Ethical and Legal Pitfalls

There are ethical and legal implications to surveillance that may impact your cases. It is important to act within the confines of the law and other regulations governing a workers’ compensation act. This also applies to the service providers you hire.

Before hiring a service provider, it is important to do your homework. Before hire them, it is important to verify the company has the requisite licenses or permits to engage in surveillance activities, if applicable. It is also important to verify the people conducting work on your behalf know the law and follow them. Checking with state agencies or business bureaus regarding complaints or infractions is a necessary step.

Practice Pointers and Effective Techniques

Given the costs of most surveillance activities, it is important for claims handlers to do their homework in advance. They should know when the claimant will be in public and report that information to the service provider. Key events can include:

• When the employee has a doctor appointments or will be seen by an independent medical examiner;

• Civic groups or organizations they belong to and when certain events they may attend will take place; and

Selecting the Right Private Eye

Other tips for effective surveillance include:

• Selecting a service provider with a track record or proven results; and

• Authorizing a service provider to conduct surveillance activities for at least two to three days in a row. It is also important to allow the investigator to work for at least eight to 10 hours per day to maximize the chance of better results.

Conclusions

Surveillance can be an effective tool to resolve workers’ compensation claims in a timely manner. It is costly so it is important to use this tool wisely and within the bounds of the law.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.