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A Case For Surveillance?

insurance money

Here are two surveillance summaries conducted on claimants who alleged severe life restrictions:

Neck injury: severe pain/restricted mobility/subject confined to neck brace. 

Excerpt from surveillance report:  Approximately 9 minutes of video was obtained of the claimant walking without any visible medical braces or devices, entering, exiting, and operating a vehicle, climbing into and out of the bed of a pickup truck, bending over at the waist for long periods, lifting a tool box and inserting it into the cab of the truck through the rear sliding window, lifting plastic buckets while in a bent over position.

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Back, neck, legs/left knee injuries/Inability to move unassisted

Excerpt from surveillance report:  The Claimant was documented walking, standing, driving, bending at the waist, turning her head and twisting her torso.  During the aforementioned activities the Claimant moved in a normal fluid manner and wore no visible braces, supports or orthopedic devices.                                                                                                                                             Video:  Approximately 10 minutes of Claimant activity was obtained on this day.

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Once again the pendulum has swung.  Business historically works in cycles.  Well in insurance claims another cycle has taken root over the past six months.  More insurance companies, TPA’s and other claims management agencies are challenging insurance claims these days.  Due to the increase in questionable, exaggerated and often times outright fraudulent claims these companies are ordering surveillance and social media searches to confirm or refute the validity of the claim.

Quality Surveillance reports today includes covert video, time stamped activity throughout the day, pictures,  locations visited, people interacted with; along with details specific to the case such as addresses, phone numbers, social media sites utilized for the investigation, case # etc.

If your claim is not adding up when it comes to the litmus test of fairness and honesty then it’s time to consider surveillance.  Cost?  Two full 8 hour days from quality investigation companies have a range of roughly $1,200 to $1,500 in total.   Not a huge amount for cases that can result in savings of 10 to 100 times or more.   A common surveillance assignment is two days where it is commonly suggested to conduct one weekday and one weekend day to observe both routines.  If no results are occurring for one or both days, a quality investigator will end the day early to come back and observe a third or fourth day to increase the likelihood of gaining quality surveillance for this assignment.

It is obvious that not every claim will call for surveillance.  This would not be prudent use of an insurance company’s money.  On the flip side, many a claim has been over-paid because the adjuster did not exercise prudent use of their company’s resources.  What criteria do you look for when deciding that surveillance would be appropriate in a claim?

This entry was posted on Tuesday, December 2nd, 2014 at 4:20 PM and is filed under blog, Featured, News & Information, Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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