Most employees are honest. A few are not. When an employee presents an un-witnessed, subjective injury workers’ compensation claim, the smart employer will encourage the work comp adjuster to verify the validity of the claim.
Some bright, but unethical employees will present a bogus injury claim, or attempt to inflate a legitimate injury, and will think about how to cover their fraud tracks. However, most employees who commit workers’ compensation fraud do not maintain their fraudulent façade consistently throughout the course of their insurance claim. Often there is information available in social media that proves the claim is bogus or inflated. The skilled insurance adjuster can frequently uncover information about previous insurance claims or prior medical treatment, but does not have the skill, the time or the capability to do private investigator type work through all the social media sites.
Investigation Firms Are Many More Times Proficient At Obtain Social Media Information
Private investigators are many time more proficient in obtaining beneficial information from social media websites than the work comp adjuster. If the social media information available is unknown to the adjuster, it provides no value. Social media information can have a major impact on the outcome of the workers’ compensation claim, but only if it is known. For example: The employee pursuing the bogus work comp claim will frequently exaggerate his/her physical limitations. The You Tube video of the employee skiing down the most difficult ski slope this side of the Alps is beneficial in controlling the cost of the workers’ compensation claim only if the employer and the adjuster are aware of the video and have obtained a copy of it.
With the electronic age, there is a lot of information available, if the person investigating the claim has the electronic capacity and the professional expertise to locate it. While some adjusters are experienced with Facebook and Twitter, it would be a rare adjuster who would be skilled in all the social media sites. Adjusters at insurance companies, third party administrators and self-insured employers normally turn to private investigators to search the numerous social media sites for information about the employee’s true physical status. A private investigator skilled in social media searches will check thefollowing list of sites and more.
• Black Planet
• Dating sites
• You Tube
The question is often asked: “What does social media sites like Classmates or dating websites have to do with a workers’ compensation injury?” The answer is employees who are committing workers’ compensation fraud think all they have to do is fool the insurance adjuster into believing they are hurt worse than they are. People have been known to post pictures on school alumni sites, dating sites and other websites of the activities they enjoy doing like rock climbing, sky diving, bowling, etc. These pictures show the employee is capable of physical activity that they have denied to the doctor, the employer and the adjuster.
Investigators Go Beyond Typical Searching
In addition to the above social media websites, a private investigator can often connect information on Craigslist, E-Bay, blogs and personal websites to the injured employee. The information on these websites may or may not be relevant to the work comp claim. For example: The posting for sale of the employee’s barbell weight lifting set on Craigslist may be due to the injury preventing further use of weight lifting equipment, or it may be due to the employee buying a newer, heavier set of weights. An inquiry by the private investigator about the price of the barbell weight set, and why the employee is selling the weight set, will provide the adjuster and employer insight into the validity of the claim.
A good private investigator will take the information provided by the adjuster and expand the known information about the employee including alternate addresses, relatives, associates, neighbors, civil and criminal records, property ownership (both residence and other real estate), driver’s license information, professional licenses (barber, plumber, real estate agent, etc.). If the injured employee is really unable to do the physically demanding job he/she had prior to the injury, it is still beneficial to know the employee recently obtain his/her business license to do something else, for example, a taxi driver’s license.
If It Is Out There, A Good Investigation Firm Will Find It
The dishonest employee presenting the bogus work comp claim may realize that he/she cannot post pictures on Facebook doing things the employee has told the doctor he/she cannot do. The good private investigator will check not only the employee’s social media websites, but also the social media websites of relatives and friends. The friend may not know the employee is pursuing a fraudulent work comp claim, and will post a picture of the employee performing an activity the employee maintains he/she cannot do. For example: the employee may claim to the adjuster that he needs a cane just to walk, but the friend may post a picture on the friend’s Facebook page of the employee’s softball game with the employee sliding into second base after running hard to stretch a single into a double.
If there is reason to believe the work comp claim is of questionable validity, or reason to question why the employee’s recovery from a valid injury is slower than normal, the employer should consult with the adjuster on having a private investigator to do a social media review. For recommendations and guidance on selecting a qualified private investigation company, please contact us.
Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: firstname.lastname@example.org.
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