Workcover and Private Investigators: the truth

Private investigators are regularly used by workcover insurance companies and here we expose how they will try to catch you. This information has been provided to me through a friend of a friend who’s husband works in the “field”.

Private investigators (and firms) are judged and rated by workcover insurance companies on their ability to “assist in reducing liabilities“. If the chosen private investigator (or the firm) fails to provide -what they call- “positive results” on a consistent basis, the private investigator (or firm) will simply be replaced by someone who will provide “positive results”.

The term, “positive results”, simply means the documentation that is required to reduce or eliminate claims.

 

Private investigators are routinely asked or forced to violate the rules, guidelines and ethics. They are often requested to skirt the laws and violate rules of evidence to defend a claim.

According to my source, the most common request by workcover insurance companies is for “selective” evidence gathering.

By selectively choosing the evidence obtained by video the private investigator will most likely fail to represent the true picture regarding an individual’s physical abilities.  This ultimately leads to a decision based on what “the workcover insurnace company” thinks is important.

Private investigators are supposed to be unbiased fact gatherers and are not to ignore any evidence discovered. They should only be concerned with the information needed to evaluate the true abilities of an individual and not try to present a one-sided view of the person they are investigating.

I have been told that there are even defense lawyers (who work for workcover insurance companies) who make unethical and illegal requests; asking private investigators to assist in “tipping” the scales to their benefit, as well as, claims reps who think nothing of violating privacy laws to obtain any information that might assist in the resolution (closure) of a claim.

The private investigator who provided this information told us that they were taught how to “rope” an injured worker/claimant, using various tactics to entice a Claimant to perform activities he/she claimed they couldn’t do. The private investigator personally has carried things like loose coins (money), an oil can, water balloons, a bicycle, a skateboard, and even “tools” matched to a specific claimant and their family.

Items such as those listed above can almost always create a “circumstance” that leaves a claimant vulnerable when interpreting the videotaped activity. Imagine the following:

  • Opening your front door and finding a walkway and/or front yard littered with coins (money) – to catch an injured person with a bad back bend!
  • Walking to your vehicle and finding you have a flat tire (usually rear passenger side) while away from home -to watch you bend/squat!
  • Having a full water balloon land and splatter a few feet behind you as you walk through a parking lot!
  • a sudden blast from a horn, or someone screaming your name!

All these “roping techniques” (which are illegal by the way) will undoubtedly provide the necessary “positive result”, captured as “that one-shot” on video.

Injured workers will often describe or use terms like, can’t bend over, use my hand, climb stairs, run, and statements like, don’t walk without a cane, climb stairs, drive, do housework and/or lawn work, and won’t be able to do that again. But, sometimes an injured worker can do those activities to some degree or another, even if for only a brief moment in time, especially when ‘startled’.

However, just because someone can bend over to pick up money from the ground on one day, does not mean it did not hurt or cause problems, subsequent to the event. The videotape will only show the “positive result” needed to discredit the claimant’s statements! The examples are endless, but it always comes down to what is seen on the videotape or read in the reports.

Other “surveillance techniques” involve looking for the injured person’s Facebook page(s) on the internet.The information of the contents of the Facebook pages(s) can then also be exploited and tried to use against the claimant. For example, pictures of holidays, pictures of the Claimant in a certain position etc, content of their posts.

Apparently another common request from a claims manager, examiner, or defense counsel is to not videotape or document anything that would support the claim. They do not want to show a claimant in a wheelchair, using a cane, or with crutches. It is not helpful to the defense to have a videotape of a right-handed claimant forced to use the left hand due to their injury, as it would support the injured person’s claim that he/she cannot.

This will only be requested if it is suspected that a Claimant is committing fraud (lodged a fraudulent claim). A good example would be an individual claiming for example a low back injury and has stated they can’t bend, lift, or climb stairs, and suffers all the time. All the while the claimant will be video-ed mowing lawns, working on cars, and participating in sporting events etc.  When the individual shows up at a medical appointment, or even better, to a courtroom, unable to walk without assistive devices, confined to a wheelchair, or so medicated (to “control the pain”) that they are barely coherent, you are watching insurance fraud occur.

Again, the above is not as common as thought; for the most part, the injured person is really injured and only has “good moments” that usually last for short periods of time throughout their daily lives. Some injuries are short lived and some are permanent in nature.

Video is thought to be the most objective information available when evaluating the true physical abilities of an individual claiming an injury. It is not objective if the investigator is selective.

These surveillances are sometimes conducted close to medical  appointments, which usually include the day of the appointment, on weekends, and holidays or special events such as birthdays.

Most often hours of videotape are reduced mere minutes when shown to a doctor, who will then write a medical opinion regarding the injury and the level of disability it causes the individual.

To avoid editing, which is not allowed, and to consistently produce “positive results”, the investigator must learn to be selective, based on the activity observed.

Scary stuff indeed!

What can I say? Watch out, make your own videos and always photograph/document your injuries!

 



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