Now that winter has arrived with a bang, it is always a ripe time for surveillance on those questionable claims. The hustle and bustle of the Holiday season is over, and people settle in to their normal winter routines, waiting out the cold weather for the arrival of spring.
For those problematic claims out there, this time of year is always a busy one for surveillance companies. Adjusters cannot wait to try and get some film of their injured claimant potentially violating their medical restrictions by shoveling out their driveways or partaking in a winter recreational sport.
Here are some tips to keep in mind for a successful hunt of trying to get that elusive film that can direct a claim from compensable to suspended:
- Strike Not Only After the Big Storm, but During It
If you are like me and do not own a snowblower, the best way to make shoveling your driveway easier is to do it a few times while the storm is going on. This makes it a bit easier to heave all the snow off of your driveway. True, the snow you are pushing may not weigh 500lb, but that is the point. Anyone with a lingering back injury is going to have a hard time pushing a shovel, and I think any doctor will lighten the medical restrictions if they see their patient spending a lot of time outdoors with a shovel. When caught, most claimants will try to say they were only pushing the snow, and not lifting the shovel. However, any activity is showing that they are active, and it can be a way to get that person back to light duty work if they are currently on a no-work status.
- Use Snow Blowing to Your Advantage
If your claimant does indeed have a snowblower, this can mean that they are not actually lifting anything. But they are on their feet, for long periods of time, pushing and pulling the blower around and being active in general. This may not mean that they are 100%, but they are certainly capable of doing light duty or sedentary work. Even if they claim that the snow blower is self-propelled, the claimant is still walking behind it, bending down, and doing this for a period of time. I would find it hard to believe that any doctor would keep this person from doing sedentary work if confronted with the video evidence. Use your tape to get them back to work, and doing something beneficial for your workplace.
- Watch For Potential Aggravation of Injury
Snow and ice are slick, and people slip and slide while shoveling and snow blowing. They are also bent over while using the snowblower which could lead to an aggravation of your current back injury claim. I am not injured, but I am sore after shoveling. If I were to already have had a lingering back injury, this is only going to make it worse. The same could be said if you are watching the video and your claimant slips and tweaks their back, or even worse they fall hard, probably making their current injury worse. The best way to handle this is to wait to show the doctor the tape until after their next appointment. In the medical notes, the claimant may show worsening signs of injury, and they probably will not tell the doctor that their symptoms worsened due to falling on their rear end while shoveling. At this time you have good evidence to show that their injury wasmade worse by slipping and/or falling down. Make sure you have the doctor be objective. By showing the doctor the film, you have concrete evidence when paired with the worsened medical report that their injury is now exacerbated by their outside activity. This should allow you to be able to be aggressive in trying to end your comp claim and move it to a personal medical condition.
- Know if they Have any Outdoor Hobbies.
Since you know these people for a period of months or years, you may already know that they love to ice fish, or to snowmobile. Snowmobiling is very arduous, since riding on the machine can lead to jarring of the back, resulting in a worsening of the injury. Even if they do not claim to be medically worsened, if you can show them active on a snowmobile, then it would seem that they are healthy enough to return to work. The best evidence you could get is if the snowmobile gets stuck and they have to get off and lift the back of the machine to get it working again. These machines weigh hundreds of pounds, and if you can do that, you should be good enough to be returning to work.
Ice fishing is not as arduous, in fact it is pretty lazy, but it can still show a person hauling their gear out to their fishing shack and sitting for long periods of time. You want to show the doctor that this person is more active than they are leading on. Once you can show that, you have some great evidence to show that this person is healthy and ready for a return to work in some capacity.
- If You Strike Out, Keep Trying
Getting some great surveillance film is luck of the draw. Sometimes there will be times that you send your vendor out and they return with nothing. That is OK, you won’t strike gold every time. But be persistent. Watch the weather reports, be aware of local fishing and skiing competitions, and send your vendor out again. If indeed you cannot gather any evidence then that is not necessarily a bad thing. This means your claimant is avoiding any activity that will make their pain worse or aggravate their injury. My friend calls surveillance “the art of verification.”
Summary
There are a lot of people out there that love the snow and the winter weather. I know people that have fishing shacks that are like a mini house, complete with TV and propane heaters. Some people snowmobile for miles in the bitter cold, and they actually enjoy doing it. This doesn’t mean that everyone out there is up to something bad, but it is a possibility. So take my pal’s advice, and verify that your claimant is doing exactly what they are supposed to be doing–which is laying low, resting, and giving their injury time to heal before returning to work.
Author Michael B. Stack, CPA, Director of Operations, 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: mstack@reduceyourworkerscomp.com.
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