Next to surveillance, social media discovery has been the Investigator’s best method for disproving workman’s compensation claims. Because fraud is so prevalent in these cases, insurance companies make it a point of investigating claims. The National Insurance Crime Bureau reports an estimated $7.2 billion in annual costs towards workers’ compensation fraud, making it an expensive problem for insurance companies.
It helps to first understand the types of fraud insurance companies investigate.
3 Types of Workmans’ Comp Fraud
Claims Journal describes three types of Workmans’ Comp insurance fraud:
Policy-Related Fraud: Policy-related fraud occurs when a company intentionally manipulates or withholds information from its insurance company in an attempt to lower its premium payment. For example, it is fraudulent for a business to inaccurately report the size of its workforce, misclassify employees or re-emerge as a new company on paper in an attempt to obtain a lower experience modification factor rating—a factor that adjusts the premium based on claims history.
Claim-Related Fraud: Claim-related fraud typically occurs when an employee falsely claims a work-related injury or illness in an attempt to gain a workers’ compensation insurance benefit. This type of fraud can be committed if an employee is injured outside of the workplace, but claims the injury occurred at work. It can also happen if an employee exaggerates the severity of an injury in order to receive a greater benefit.
Medical Provider Fraud: Medical provider fraud is committed when a medical provider deliberately attempts to profit off the workers’ compensation system by unnecessarily performing services on a claimant solely to collect an insurance payment. Fraudulent billing and kickback schemes with pharmacies or medical specialists are other examples.
Claim Related Fraud
This is the most common fraud case that most investigators are hired for. We have conducted hundreds of deep web scans on individuals who are suspected of fraud. Many times we identify contradictory photos posted in social media. For example, a claimant has back related issues, but can be seen in a social media post water skiing.
If attorneys are involved, many times the claimant is advised to be careful what they post in social media. They may be instructed to tell their family and friends not to tag them in any photos. The set their privacy settings high.
In fact, there is even software out now that can help attorneys monitor their client’s social media accounts for them. It is called Private Footprint. They describe their software as, “Client Social Media Monitoring for Personal Injury and Disability Lawyers”. It is an interesting approach and I wonder how many attorneys are using it.
In any case, it makes it more difficult for the investigator. We can always tell when a person has been advised to lock down their social media. Even so, there are times when photos are out there on friends and family members social media that the claimant does not remember.
In the end, people over share in social media. This can be a key factor in gathering evidence in a case and it is always worth it to check. You never know what you will find until you look.