Insurance companies will often use different types of surveillance, including hiring private investigators to identify fraudulent claims and even avoid paying for legitimate ones Their goal is to catch you doing something that goes against the restrictions set by your doctor and then use that to reduce or deny your worker's compensation benefits.
So anyone filing a worker's comp claim needs to understand how surveillance works and how to avoid accidentally giving insurance companies evidence that can be used against you.
While surveillance can happen at any point in your case, oftentimes it's used as your claim approaches or after you reach maximum medical improvement or “MMI.” This is where the insurance company typically looks to settle your claim, so they want to collect all the evidence they can to either reduce how much they pay you or deny your benefits for permanent disability altogether.
Remember something: it costs the insurance company money every time they hire a private investigator, so not all cases will involve one.
Some of those cases with the highest likelihood of being investigated include:
Some of the signs of fraudulent cases that insurance company look for are:
Sometimes insurance companies assign investigators to random cases, so even if none of these apply there's still a chance they're going to look into your activity. Should that happen, most investigators will monitor you for a period of several days, often during a time when the insurance company knows you'll be in public such as during a doctor's visit. But keep in mind that they can surveil you at any time during the day or night, not just 9 to 5!
Insurance investigation is tailored to whatever issue triggers it. For instance, if you have a history of making claims, they're going to look for preexisting conditions and older cases rather than just following you around the camera. If an injury occurs without any witnesses, an investigator might focus on interviewing other people who could provide insight about the event instead of just stalking your social media.
Some of their methods of investigation include:
And as social media has become more prevalent. It has also become a popular way for investigators to collect evidence against you. They will not only look at your posts, but they'll also look at the post of your family and friends in attempt to catch you doing something you shouldn't be doing. So be mindful about what you post on social media and what other people post about you.
Basically, a private investigator can do anything within the law to build evidence against you and your claim. What they can't do is anything that breaks the law, not only because it's illegal, but also because any evidence gathered illegally may not be admissible in court. So you don't need to worry about them doing things like recording you in your house, hacking your social media or putting a tracking device on your car.
In most cases the investigator isn’t trying to prove that you’re not injured, but looking for proof that you’re not as hurt as you say you are. If they can get evidence of you violating the medical restrictions that were ordered by your doctor, then they have a good chance of reducing or denying your workers comp benefits.
For example, if your doctor has ordered you not to lift more than 10 pounds, but then out of habit you pick up your toddler and put them in the car while a private investigator is watching, it’s not going to be good for your case.
Another big one is driving. If your doctor has reported that you should not be driving and the investigator gets you on camera in your car, your case is going to pay the price.
They’re also looking for inconsistencies, like if you go into a doctor’s appointment with a limp but are seen walking normally when leaving your house. Another way they find inconsistencies is by comparing notes between your doctor and the insurance company’s doctor. If you told the IME doctor that you can’t sit for more than 10 minutes, but told your doctor that you could sit for 30, they’re going to find out.
So make sure you’re always honest and upfront with everyone involved in your case, because bending the truth will come back to bite you!
If you have a workers comp claim, the most important thing to do is assume that you’re always under surveillance, that way you never slip up. Make sure you follow your doctor’s orders at all times and don’t accidentally do something out of habit, like lift your kid into the car when you’re not supposed to pick up heavy things Also, don’t overstate your restrictions to the doctor, this will ensure they match reality and reduce the risk of you getting caught violating them.
And remember, appearances matter. If you’re not supposed to do anything involving heavy weight and the investigator catches you on video using your self-propelled lawnmower, it can hurt your case even though the lawnmower drives itself.
And finally, if you can anticipate situations where you might need to violate the doctor’s orders, be open and honest about them upfront. Tell the insurance company’s doctor that there’s nobody else available to pick your kid up from school, so you grit your teeth through the pain and do it yourself. This way they probably won’t even bother putting surveillance on you because you already admitted to it!
My name is Rex Zachofsky, and I’ve been a workers comp attorney for the past 17 years. If you or a loved one have been injured on the job here in New York and would like to set up a free consultation with an experienced lawyer who will fight for what you deserve, give me a call at 212-406-8989 today.
Our conversation is confidential, costs you nothing, and can potentially get you thousands more in benefits than you would otherwise receive!
And if you plan on settling your case, be sure to watch my other video about when you can expect the insurance company to send their offer.
In it I explain the exact moment when you can safely settle your case for the largest possible amount, and what circumstances might cause the insurance company to settle sooner rather than later.