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From extreme sports competitions to amateur football and twerking, workers compensation investigators have uncovered many instances of workers fabricating injuries and pain.
Employers must be committed to helping workers suffering from bona fide work-related injuries, but they also need to take steps to validate questionable injuries and vet social media to uncover fraudsters, said experts at a Wednesday session at the Risk & Insurance Management Society Inc.’s 2021 conference, which was held virtually.
While the “best claim is the claim that never exists … (employers) have to have a key vision — pay the claims that are owed and defend the claims that are not,” said Steve Figliuolo, Atlanta-based principal program lead, enterprise risk management for program lead Chick-Fil-A Inc. “If you’re an employer, but stories just aren’t adding up, it’s important to really look at things and see what are the actual objective findings that are coinciding with any subjective complaints.”
When it comes to investigating injuries, the wealth of information involved with social media has made it easier to scrutinize and surveil those claims, said Kevin Lederer, regional account manager for Command Investigations LLC in Orlando, Florida.
“Over 90% of millennials are using social media … half of the baby boomer population are on social media in some sort of fashion,” he said.
For example, one woman who claimed she was unable to drive or bend at the waist was not an avid social media user, but through her husband’s social media accounts — and public pages from an extreme sports race — investigators learned that she was participating and obtained surveillance in just one day of her crawling through the mud and engaged in other activities that directly contradicted her claimed abilities, according to Mr. Lederer’s presentation. That surveillance saved the company more than $80,000 on her claim, he said.
Another claimant who said his pain was so severe he couldn’t sleep at night was caught playing football on an amateur team and another who said he was unable to work was caught spinning and twerking with a group in a dance studio. Both surveillance leads were gleaned from social media, Mr. Lederer said.
“There are times you are going to have claimants that are legitimate,” he said. “But when you find someone that is being untruthful with you ... doing a social media investigation on someone who is active (on sites) or has links that are active and monitoring those — it’s going to save everybody money in the long run.”
Two men charged with multiple insurance fraud counts stemming from bogus screenings and prescriptions for injured workers surrendered to authorities last week, the California Department of Insurance announced Wednesday.