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Employer snooping cuts comp claim costs

Posted On: Jun. 25, 2015 12:00 AM CST

Employer snooping cuts comp claim costs

Surveillance and social media investigations can help workers compensation payers close exaggerated claims, sources say.

Surveillance often comes into play when there's reason to suspect injured workers are “embellishing” their symptoms, said Maureen Farran, Portland, Oregon-based technical operations manager of the claims division at third-party administrator Broadspire Services Inc.

In a recent ruling on the subject in Angela Malone-Watson v. Strategic Restaurants Acquisition Co. L.L.C., the Burger King employee said she sustained injuries to her ankle, arm, hip, back and knees when she tripped over a bread tray at the fast-food restaurant in Baton Rouge, Louisiana, according to court records.

She filed a workers comp claim in April 2013.

However, one year later, a judge granted Strategic Restaurants summary judgment in dismissing Ms. Malone-Watson's claim due to “video surveillance recordings, as well as other documentation,” that showed she “willfully misrepresented her symptoms,” according to court records.

Since she did not object to the evidence on appeal, Ms. Malone-Watson forfeited her benefits, a Louisiana appellate court ruled earlier this month.

Broadspire is listed as the TPA for Strategic Restaurants in the ruling, but Ms. Farran declined comment on the case.

While less than 10% of workers comp cases involve surveillance, it is a longtime method that workers comp payers use to leverage settlements or get physicians to reconsider restrictions placed on injured workers, sources said.

What's new is the social component of surveillance, sources added, which includes investigating an injured worker's Facebook, Instagram and other social media accounts.

“Any surveillance starts with a social media review,” Ms. Farran said. “It's standard operating procedure now.”

“Payers of workers comp claims are the ones that ultimately bear the cost of the investment,” said Debra Levy, senior vice president of work comp product management and national work comp practice leader at York Risk Services Group Inc. in Atlanta.

Adjusters need to make sure they have a good lead before moving forward with surveillance, which Ms. Levy described as a “costly tool.” Investigative firms generally charge about $800 to $1,000 a day for surveillance and most investigations run two days, she said.

Such surveillance needs to capture “regular behavior that keeps occurring” to refute the injured worker's independent medical review or deposition about their injury, Ms. Levy said.

“So long as (surveillance) doesn't violate someone's privacy or result in a trespass … what one can see out in the public is fair game to capture on video,” Tracy W. Cary, a Dothan, Alabama-based partner at Morris, Cary, Andrews, Talmadge & Driggers L.L.C., said in an email.