A couple of days ago, our anonymous “insider” [a former Allianz case manager] kindly responded to our questions about workcover surveillance and what it is they are really looking for, or hoping to find when they put injured workers under surveillance…
Workcover surveillance – what are they really looking for?
Fact is, says the former Allianz case manager, many workcover case managers will use surveillance on many injured workers “to get an actual glimpse of what the injured worker is up to on a day-to-day basis”. The main reason surveillance is used for, is of course, to defend a claim, to mitigate liability, to deny (further) benefits and/or to close a file. However, sometimes surveillance can yield no valuable results towards an “action” on a”case’.
Our “insider” tells us that s/he was trained to know what to look for in the surveillance footage and how to use the footage to his/her [Allianz] advantage, obviously in order to assist with the defense of an injured worker’s claim.
What they are really looking for in the surveillance footageConsistency of objective evidence of an impairment/disability
One of the main things a case manager will have to look for in surveillance footage is consistent and objective evidence of an impairment/disability. Consistency is key.
The case manager will look for example at the way the [injured] worker is walking, are they limping? Are they using a cane? Crutches? Other supportive devices? If they suffer from a shoulder injury, are they wearing a sling? Are they able to use their arm, i.e. to remove the mail from the post box? Basically the case manager will look if the worker is actually as impaired or disabled as claimed by their treating doctor(s)/physio/rehab provider.
Remember, says the former case manager, that case managers use a guide which shows the expected recovery time of each injury, and if an injured worker does not “recover” within those set time frames, usually surveillance will be recommended! [How sick, being medically trained I believe we're all unique and we all heal differently!].
The former case manager tells us that it is- however- important that the “overall way an injured worker is moving be assessed” and that, contrary to popular belief, “having some actual 10 second surveillance footage of an injured worker doing something they should not be doing does not mean it works in the case manager’s advantage”. We all know some private investigators are known to use extremely dirty tactics in order to capture those famous 10 second video shots.
A typical and common example would be an injured worker who claims to suffer from a knee injury. Surveillance footage shows that the injured worker, when shopping at the local supermarket, was walking normally, without a limp, without crutches, cane and/or other support. Then, at a scheduled independent medical examination (surveillance is very often used at IMEs), we suddenly see the same injured worker walking with a very noticeable limp, and/or with assistive devices…
However, the former case manager says that “still this may not be sufficient evidence as the injured worker may be able to claim that s/he had a good or a bad day that day”. “That’s why it is so important to have multiple days of surveillance“.
In a typical “fraudulent” case surveillance would then be able to show that the “injured worker” only appears to be impaired or disabled around a medical place (i.e. independent medical examination, doctors appointment etc), and in this case there may be a decent case for a defense, says the former case manager.Are crutches being used? Is a cane used? Are they actually used and used correctly?
Our insider tells us that case managers will also look at the surveillance footage to see whether, for example, if a person has a leg injury, and crutches or a cane have been prescribed, they are using these correctly [WTF!]. Apparently there are many injured workers out there using canes or crutches incorrectly… Now, now, we do wonder how on earth an uneducated, non-medically trained case manager is able and even allowed to make a judgement on whether someone is using their cane or crutch correctly, duh?
Well, our “insider” tells us that case managers will pick up on surveillance footage, for example, if an injured worker is carrying their cane or crutch, when walking [and thus not using it]. This apparently means that the prescribed cane/crutch is not helpful to the injured worker! Wow… we just wonder about those poor injured buggers who are trying to make an effort to walk without assistance, but still need the “assurance” or “security blanket” knowing that they have their cane/crutch/whatever in hand, should they need it!
Hell, after one of my shoulder reconstructions whereby I had bits and pieces taken from my right leg and transplanted in my right shoulder, I found myself in a sling for 3 months and on 1 crutch (as I was unable to use 2) for 6 weeks… Now YOU try and hobble with a crutch whilst your right arm is in a sling… correct….
Now, obviously if an injured worker only uses a cane or crutches in the vicinity of a medical facility (i.e. IME), and, for example, after leaving the IME, just tosses the cane/crutches in the boot of the car, is then tailed by a private investigator and filmed not using the cane/crutches when s/he arrives home… and not when s/he walks around the next day and the day after that, yeah, sure, maybe that warrants “further investigation”.Is the injured worker following medical restrictions?
Another “great piece of evidence” is obtaining video surveillance from the injured worker breaking their prescribed medical restrictions, says the former case manager. This can include, for example, lifting and carrying [groceries] more than is allowed by the doctor, bending, exercising etc. If your doctor states that you should not be on your feet longer than needed but we see you hiking, surfing, swimming etc, this will be held as evidence against your claim.
There have been cases where injured workers’ video surveillance footage was used as enough evidence to settle claims at a fraction of the cost [compensation], or enough so the injured worker gives up and does not pursue his/her claim any further.
- workcover and private investigators the truth
- worksafe spends 15 million on secret surveillance on injury victims
- a workers compensation private investigator tells it all
- how workcover insurances use surveillance to deny a workcover claim
You can find more surveillance articles by typing the keyword “surveillance” into the search box [and wait for results to come up in a blue box... ]