When NOT to Use Surveillance on Your Claim

Surveillance is a powerful tool, but there are three characteristics that could suggest surveillance is not the best use of your resources.

Immediately Following Surgery

Some people simply do not follow their providers’ recommendations about what they should do or not do after surgery or a medical procedure. Some people may also have a high tolerance for pain, or may be taking pain medication as they exert themselves beyond their providers’ recommendations. Even if video shows a claimant water skiing after a rotator-cuff repair, it might not be enough for the provider to change the course of treatment or benefits. The provider might simply point out that it would be better if the claimant avoided the activity.  

Recommendation: wait an appropriate amount of time after a surgical procedure before conducting surveillance. 

Inactive Lifestyles 

If medical reports show that a claimant lives a sedentary lifestyle and only evidence of significant activity is required, surveillance is probably not the best tool. Evidence of a sedentary lifestyle is sometimes observed on social media, showing that a claimant watches hours of television or plays hours of video games. Lifestyle evidence may also be found in medical reports and notes about lack of exercise or fitness. Providers might note activity characteristics or social media may provide insights about sports or other active hobbies that could suggest the potential value of surveillance.

Recommendation: when considering activity-related surveillance, review medical reports. 

Extreme Restrictions 

Surveillance may not be the best tool if the claimant’s restrictions are extreme and unlikely to be exceeded. Some job descriptions require a certain level of physical ability. For example, firefighters must be able to carry a person down a ladder in order to return to work full-duty. If it is unlikely video would provide evidence, we would not recommend surveillance. Another example: if a claimant alleges he or she can only stand for one hour at a time in a job that requires standing for an entire shift, it is unlikely that surveillance would gather enough information to impact the claim.

Ask These Questions

Claimants tend to focus on what they can’t do when meeting with their medical provider. Surveillance video shows what they can do, giving providers the facts they need to provide the best course of treatment.  

• Does the claimant really need a cane to ambulate?  
• Is the claimant truly unable to drive, walk, bend or lift?  
• Is the claimant too injured to return to work, even in a modified capacity?  
• Is the claimant’s psychiatric injury so severe that he or she is unable to leave the house or socialize?  
• Is the claimant working another job while collecting temporary total disability?

Surveillance is the perfect tool to provide answers to these questions and more. Even just a few minutes of video can confirm a level of disability or put a questionable claim back on track.  VRC Investigations can help you decide on the best approach for your claim.

DALENE BARTHOLOMEW, CFE, CIFI

Dalene Bartholomew is a Certified Insurance Fraud Investigator, Certified Fraud Examiner, Vice President of VRC Investigations.  She enjoys building long-term strategic partnerships with insurance carriers, employers and TPAs and providing innovative insurance fraud solutions and fraud abatement programs resulting in hundreds of insurance fraud prosecutions nationwide.  A forward-thinking senior executive with a 20-year record of success combatting all lines of insurance fraud, she was awarded “Fraud Fighter of the Year” by the Anti-Fraud Alliance.  A recognized speaker, author, insurance fraud specialist, expert witness, fraud advisory board member, and wine enthusiast.  DaleneB@VRCinvestigations.com