Stopping Fraud with Video Proof
6 Action Steps to Use When Contacting the Physician
When an employee makes a work-related injury that limits his/her ability to work, it’s time for documentation.
When said employee is observed elsewhere doing the very things they say they cannot do, it’s time for investigation. Make sure to do enough investigation so you record the activities over a long(ish) period of time. This is to avoid what is known as “good day, bad day syndrome” — meaning the employee has some good days and some bad days. If you have only a brief snapshot of activities, it is not an indication of overall condition and in a hearing the judge may rule the evidence is not enough to prove inconsistent activity.
And when an investigation provides video of fraud, it’s time to remedy the situation.
Here’s what to do:
1. Send your video proof first class mail, certified and return-receipt requested to the employee’s doctor and include all your contact information, employee name and claim number. Or, take it to your company’s consulting doctor, also called a medical advisor or peer-to-peer, and meet with him/her first to share the information and discuss whether the activity (if prolonged) is contrary to what you are being told about their abilities
2. Explain the situation to the physician that has given a prognosis of “not able to work”, this is usually the employee’s treating physician. Say something like, “You indicated on a Disability Form provided to Mr. Hayes he was unable to work because he had very limited range of motion in both arms. In light of the investigation videotape and report enclosed would you please review the situation and determine whether Mr. Hayes’ range of motion is still very limited. Our investigators observed Mr. Hayes on five consecutive days one week and several days the following week, doing landscape work with a local landscaping company. Additionally, over the weekend he was observed riding his motorcycle for several hours at a time. He was doing these activities with no apparent physical or medical limitations.” (workersxzcompxzkit)
Also in this letter, you should:
3. Ask the physician if he or she agrees the employee is now able to perform his original job as XXX and request an amendment of the work ability form report to indicate such and fax it immediately to your office.
4. Enclose a new Work Ability Form for the doctor to amend with the new, proper physical restrictions, if any.
5. Include your phone number and encourage the physician to call with questions.
Author Robert Elliott,executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
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