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Surfing social media to fight comp fraud

Surfing social media to fight comp fraud

CHICAGO — Social media posts by unsuspecting workers compensation and liability claimants can provide a wealth of evidence for insurance fraud investigators, but the online investigations need to be conducted quickly and ethically, experts say.

Workers claiming disability payments gift investigators evidence when they post photos of themselves being fit and active on Facebook, for example, but only if the images are shared publicly, they say.

Christopher E. Curl, president of Batavia, Illinois-based consulting firm C.E.C. Group L.L.C., said he has seen major employers use social media to their advantage in claims management. One large grocery chain he has worked with conducts social media research for auto and general liability claims, while he knows another employer that researches social media profiles for all workers comp lost-time claims.

“It’s just another way to fight insurance fraud,” Mr. Curl said.

Mr. Curl and others discussed the value of social media in claim investigations during a panel presentation at the Chicagoland Risk Forum, hosted late last month by the Chicago and Mid-Illinois chapters of the Risk & Insurance Management Society Inc.

Robert Johnson, Chicago-based managing partner with consulting firm Solomon Group L.L.C., said social media investigations can be particularly helpful in determining how much to reserve for workers comp and liability claim costs.

For instance, he discussed an investigation where a workers comp claimant who claimed to be permanently and totally disabled was discovered through social media to be working a side job as an exotic dancer named “Romeo.” That information decreased the value of the man’s workers comp claim “tremendously,” said Mr. Johnson, who is also a partner and chief diversity and inclusion officer with the Quintairos, Prieto, Wood & Boyer P.A. law firm in Chicago.

“Anything you can do to get a more accurate view of what the exposure is (can be) valuable,” he said.

By using specialized social media investigation software, it’s possible to find out a person’s address, phone number and their relatives or associates by indexing sites such as Facebook, Twitter, Instagram and YouTube, said Lou Vittorio Jr., Naperville, Illinois-based assistant vice president with Frasco Investigative Services.

Social media users may not always make such information publicly available, Mr. Vittorio said. However, by researching the profiles of a claimant’s family and friends, investigators usually can find pictures and other information that has been publicly shared about the claimant.

“We’re going to go into those profiles and typically we’ll find one or more are public, and we’ll find information on that subject,” said Mr. Vittorio, who said investigators at his firm may spend up to three hours on such investigations.

Geofencing also is a powerful tool for social media investigations, Mr. Vittorio said. The practice involves using GPS or radio frequency identification to identify geographical boundaries within software.

With geofencing, Mr. Vittorio said investigators can search for public social media posts that were uploaded within a certain distance of an incident.

For example, bystanders might share video or photos of a car accident on social media. Mr. Vittorio said investigators working on insurance claims related to that accident can search for any publicly shared posts that were uploaded within a geographic range set by geofencing.

“A lot of times, we can find potential witnesses,” he said.

While social media can provide valuable information to prove insurance fraud or abuse, investigators need to be sure that they conduct such research appropriately, Mr. Johnson said. He said investigators should not try to “friend” or connect with claimants they are researching on social media.

“You want to make sure you’re acting in an ethical way and not trying to go around any privacy settings they have,” Mr. Johnson said.

Michael Airdo, a partner with law firm Kopon Airdo L.L.C. in Chicago, said every company looking to control workers comp and litigation claim costs should use social media research to their advantage.

Companies should index information on claimants’ social media profiles as soon as possible after a claim is filed — before the person can edit their social media presence, Mr. Airdo said.

“Once this person has the value of having a conversation with his or her lawyer, that information disappears,” he said.