Claimant Arrested for Fraud

As reported in this article a claimant was indicted on suspicion of stealing $140000 in funds from Pinnacol Assurance, the insurer handling more workers compensation claims in Colorado then anyone else. The spouse was also indicted. In my experience this is relatively rare. A claimant may exaggerate his condition but seldom is it outright fraud. Some employers are much more likely in my experience to intentionally coverup claims made by employees. In any event this news is unfortunate as it suggests that surveillance be used in many cases. There are many claimants who must be put through this process even though they have legitimate injuries. Yet insurers do not just look for fraud they also look for any possible evidence that helps them to defend the claim. There are very few arrests but there are many cases where the insurer has evidence the claimant can do more then is recommended by his doctors. So judges may be shown this but also doctors. If you exceed your restrictions and that is videotaped then your case has not only been weakened but your doctor may become quite upset with you which also makes him question your treatment and future needs.

Social Networking and Online Privacy

Over at the Legal Talk Network there was a recent podcast that details much information about how websites like Facebook can affect a workers comp claim. For that matter anything online can be information that is used by the other side. Even employers can check into employees or prospective employees online. Investigators or insurance adjustors are very interested in finding out about claimants. Moreover the information you post is forever online or so it seems. In this podcast there is a very interesting discussion on this and it can also be useful for attorneys. I also noticed another podcast on surveillance and it is also revealing about what is done when surveillance is requested. Both of these podcasts are fascinating but are provided here for general information. Much of this may apply to Colorado but perhaps not all. I can say that if a claimant has a high value claim or claim for a serious injury or has something that raises a red flag that insurers will gather up information which can be from online sources or private investigators. Every claimant should be careful with their online or public activities. Even discussions with friends, neighbors or co-workers can affect the claim.

The New Surveillance

Years ago I would tell claimants that they must be careful as they often are followed and videotaped. Often this is not just to find out if you are a faker. It may also show how functional you are compared to what a doctor may be saying. If you doctor says stay off your feet or don't lift more then 10 lbs and you are videotaped walking around for a prolonged time or lifting 20 lbs it hurts your case even if it were one time or after taking pain medication or whatever. Such surveillance does not show the details or that what you did may have exhausted you. It just shows you more functional then what your doctor may have said. I would tell them to follow your doctors restrictions or if you are really having problems to limit your activities at all times. No one is invisible when they go out in public or can be seen from a parked vehicle. Surveillance videos can be shown to a judge and to your doctor so be careful. Doing something one time just because you push through the pain or take something to help with pain is using poor judgement. Get help when you need it or as with shopping shop more often but never disregard your doctor or your own well being. Anyway those were simpler times and now we must all think about new ways to find out about you. Be aware that going online or posting information on Facebook or wherever can be located and often obtained as noted at this other blog. Your activities, your resume, your dreams, your abilities and your goals should be kept private during the workers compensation claim process. To me private means don't do it at all as thinking you can restrict access is foolish thinking. Further be extra careful with emails too. Those you think are your friends or co-workers can retain emails and they may in some way be used against you. Discussions about your health, your job, your claim and others related to any of that should be severely restricted and ideally eliminated during your claim. A failure to act wisely can mean losing your doctor even your attorney and perhaps your case. Surveillance nowadays is not to be taken lightly.
UPDATE Sep. 29, 2010: If anyone thinks that Facebook or other online social networks are not being noticed by attorneys and insurers please look at this detailed legal article that reviews the situation. Moreover investigators can have a motherload of information to use against claimants. Restricting access may not stop them. You may not even realize how it can be used but others know better. For example you go to a rock concert and post about it. It was fun; it lasted 2 hours and everyone was on their feet the entire time. But what did your doctor say? Did he restrict your standing? So now you are seen disregarding your doctor. My view...anyone with such an account should cease posting for the duration of your case or be at risk.

Pinnacol Again in the news...for golf getaway.

The Denver Post is reporting that Pinnacol Board members were at a Pebble Beach golf resort where a round is $500 and the room rate starts at nearly $700 a night. Pinnacol is partly private and partly public. They are the largest workers compensation insurer in Colorado. Looks like the media is investigating the expenses of the trip and Pinnacol is asserting its records are confidential business documents. Pinnacol has been a state agency/political subdivision since 1915 but has been given more autonomy over the years. It has sought even more independence but is also under some scrutiny. This latest news is certainly keeping them in the public eye. Pinnacol can surveil injured workers. Looks like the shoe is on the other foot right now. The comments following the news article are also interesting.
UPDATE: This is an interesting read but mostly focuses on Pinnacol must change its ways.

Pinnacol's Position on Pending Bills

Here is a link to Pinnacol's viewpoint on the currently proposed bills at the Colorado legislative level. They have expressed disapproval of the proposed bill to limit surveillance by saying an investigation is not just to stop fraud suggesting the bill is too restrictive. However my experience is that surveillance is sought to try show the claimant is exaggerating. Some investigators will follow claimants almost everywhere. They follow when you enter the supermarket, or pump your own gas, or go for walks or trim your weeds. Then they allege you can work or are not that disabled because you are seen as functional in the video. Hours of surveillance are edited down to minutes which fail to disclose all the poorly functional moments. Doctors and Judges may be faced with a tough problem when determining what is the truth. Some claimants have told me that they had taken an extra pain pill or took hours to do the task or then had to lay down but none of that is on video. But the video suggests they were doing fine. But the biggest problem I have with surveillance is the level of stalking it implies. Big Brother is watching you! Also Pinnacol is opposing the bill on conflicts of interest by claiming this is already disclosed but many would disagree with that. In any event Pinnacol does set forth its viewpoint on all these proposed bills.

Three Proposed Colorado Bills

In 2010 we will see several bills that are introduced which would impact Colorado Workers Compensation if passed. Three that have already been submitted are interesting. The first concerns putting restrictions on surveillance. Many claimants are followed and video is taken as part of an insurers investigation. I remember once walking into an opposing attorneys office and seeing mounds of videotapes. Anyone with a workers comp claim should expect surveillance especially when they go shopping. In any event read this proposed bill on surveillance here. Another proposed bill concerns increasing penalty claims from $500 to as much as $1000 a day. Read this proposed bill on penalties here. Finally another proposed bill seeks to address what it considers conflicts of interest with certain medical doctors. I would assume this is effort to prevent too cozy relationships between some doctors and Respondents. Read this proposed bill here.

Be Careful What You Post Online

Anyone with a workers compensation or Social Security disability claim would be wise to remember that what you post online may be accessed by others. So your profile on Facebook or elsewhere may come back to haunt you. We all know that many with claims are investigated and even videotaped but what you post online may also be subject to review. Here is an interesting article that makes the point very well. If you post about yourself and all your interests then that can raise a question about the severity of your disability. So a word to the wise...do not imagine you are invisible and won't be checked out. From digital cameras to Facebook or even other postings elsewhere you had best assume they will discover all this. In this digital age your life could be an open book so with any injury or disability I suggest you cease...that means STOP all such postings for the duration of your claim or at least be extremely careful what you post.
Postscript: August 23, 2009 Dollar Tree uses claimant's MySpace to bust his case.

Claimant Fraud or How Not to Be Well Heeled

The typical claimant on workers comp seeks to maximize his benefits. There is no reason to not receive all available benefits. However in this link we have a claimant in Connecticut that went beyond that. Insurers love to use such stories of fraud to justify tightening up on workers comp rules and laws. Such instances of fraud then can hurt the average claimant. By and large most claimants just want to get treated and back to work if at all possible. But at times someone decides to be false and deceptive. Not only can that be criminal it also affects all the other claimants. It can result in insurance adjustors and employers thinking all claims are suspect. By the way the instances of employer wrongdoing are actually more common. Many times employees with legitimate claims are treated poorly by their employer. Claimants are fired or demoted or ostracized. To save a few bucks I've seen employers put claimants back to work reading the phone book just to have them collecting regular pay rather then workers comp. In any event all claimants should know they are not invisible and surveillance is common. Check out the Connecticut story here.

Surveillance Videos

Many times in a workers comp claim the claimant is surveilled and videotaped. It is not usually illegal to videotape someone out in public view. It is then shown to a doctor and even to the Judge. Of course such videotaping never shows the claimant going in to his residence and having to lay down. It never shows someone struggling to get up in the morning. It also can be edited to show activities not in line with what the doctors are saying. In one recent appealed case the claimant was seeking permanent total disability benefits and there were doctors who examined him along with vocational experts on each side to provide opinions on his employability. He lost his case for this in great part I am sure to a videotape that showed him more functional then how he presented to the doctor. When the doctor says 10 pounds lifting and you lift 30 lbs you are out of line with your doctor and setting up to lose or greatly reduce your benefits. I've seen surveillance of claimants in retail stores, outside walking the dogs, gardening, washing the car and lifting and carrying boxes. If you violate what your doctors say are your restrictions then don't complain when it's revealed to all. Saying you had to do it or were medicated at the time does not alter the situation. Saying it was painful and afterwards you laid down is still not very good. Videotaping happens in many cases and can take place at any time or multiple times. Imagine the shock to your doctor or lawyer when this is shown to them. Imagine what goes through the Judge's mind when he sees a claimant gardening but saying he can't work. There really is no good excuse for exceeding your restrictions medically or legally.