Today as insurance premiums continue to escalate to unprecedented levels, employers look for a way to provide workers compensation insurance coverage at a reasonable cost in the event that an employee is injured on the job. Unfortunately for the employer, employees who are said to have been injured on the job periodically abuse Workers Compensation. The magnitude of this problem is staggering nationwide with some thirty to forty percent of all work-related claims being fraudulent or exaggerated. This fraudulent activity results in a forty to fifty billion dollar annual loss to the insurance industry, which is absorbed by employers directly and the individual insurance consumer indirectly. Unfortunately this "trend" of fraudulent activity seems to be on the rise as employees sometimes see fraudulent compensation as a lottery of sorts to effortlessly collect money at the employer’s expense. The major categories of fraud and the methods by which they are achieved are too numerous to mention within the scope of this text. Due to this fact, we will concentrate on claims fraud and specific ways that unnecessary claims payments and "washout" settlements can possibly be avoided.
Case managers and claims adjusters are the front line of defense against Workers Compensation fraud and are under increasing pressure to assess potential cost of each claim, as well as assess the overall severity, permanency, and degree of impairment to each claimant. This problem can be addressed through a number of reduction strategies:
- Identify exaggerated claims or possible fraud
- Maintain an integral part in the claims process
- Identify "red flags" that are indicators of suspicious activity
- Investigate all suspicious activity through the use of surveillance to document the claimant’s daily activity during the claim period.
Surveillance can provide assistance with:
Documentation - video surveillance documentation provides a permanent record of the claimant's activities and condition during the claim period. This information can be used comparatively or directly to refute the claimant's allegations of injury. This documentation is of primary concern to treating physicians, consultants, and adjusters/case managers.
Negotiations - Video documentation is demonstrative and cannot be refuted, as is the case with still photography or testimonial evidence. Since claimants will exaggerate the extent of their injuries to the employers, this same exaggeration will likely take place with the claimant's attorney. Once the attorney has been provided with clear video evidence as to the lack of injury of the claimant, excessive claims are reduced to reasonable settlements or often completely withdrawn.
Prevention - Aggressive use of surveillance enhances an atmosphere of diligent claims administration and heightens employee perceptions of the employers and claims adjusters’ willingness to actively pursue claims.
Anderson Investigations offers complete surveillance coverage from Pensacola, to Lake City, Florida, southern Alabama and southern Mississippi. All surveillance is conducted by licensed private investigators operating under Anderson Investigations license, insurance and bonding.
Anderson Investigations utilizes a wide range of video technology that can accommodate most situations allowing us to follow and document subjects without detection. Anderson Investigations routinely conducts surveillance in very rural as well as heavily urban areas.
Surveillance is routinely accomplished effectively through the use of two (2) eight to ten hour days unless otherwise specified by the client. All surveillance is billed per hour or a day rate can also be utilized. Experience has proven that any segmented blocks less than four hours is not indicative of the claimant’s activity level and could possibly become the subject of scrutiny under negotiations.
Verbal reports are made to the client on a daily basis concerning the status of the case. Written reports are submitted to the client within (5) five working days of completion of the case via standard first class U.S. Mail. Fed-EX, UPS next day service or fax can be accommodated for time sensitive cases. Anderson Investigations follows a standard report format but can accommodate and tailor reports to fit the client’s need.
Scheduling is usually done within five (5) days of receipt of authorization from the client unless the case is time sensitive. The agency works in close conjunction with the case manager and can accommodate special circumstances surrounding the case such as doctors' appointments or tips from informants.
Anderson Investigations utilizes High-8mm video for most video documentation. High-8mm offers the highest quality video clarity for reproduction since long -range high- powered equipment is often utilized. Videotape is then dubbed onto a DVD format for viewing. Digital Video is the most commonly accepted format and is what the Court of Compensation Claims, and most attorneys and doctors will have at their disposal. Other formats can be supplied upon request.
Anderson Investigations can provide still photos taken from the video obtained for interpretation and analysis. While every case does not lend itself to this technology due to unforeseen circumstances, in most cases still video capture will be attempted and a reproduction forwarded for analysis. For clients equipped with computer video software, photos can be forwarded via the phone line and printed over a standard printer.
In addition to surveillance, Anderson Investigations offers a full line of investigative services including background investigations and witness statements to name a few. These services can be effective in initial determination of accident circumstances. Anderson Investigations can also assist in internal investigations for problems such as employee theft as well as "in house" surveillance. If there are any special requirements within our investigative parameters, we will be happy to design a program to fit the specific need.
Anderson Investigations is licensed (Lic# A-92-00365) as specified by Florida Statue 493 and all other states where licensing applies. The original copy of this license is displayed at the main agency office and a copy can be supplied upon request.
Anderson Investigations is insured as specified by state laws and maintains a copy of this license in the agency's main office. A copy of this documentation can be provided upon request.