orkers’ compensation claims investigators are increasingly scouring popular social networking Web sites such as Facebook, MySpace and LinkedIn to help insurers and employers fend off bogus claims.
Some claimants supposedly too disabled to work post locations and dates for their upcoming sports competitions or rock band performances, boast of new businesses launched and include date-stamped photographs of their physical activity, investigators say.
Others have openly bragged about fooling their employers with “Monday morning” workers’ compensation claims for injuries that occurred the weekend prior and away from the workplace.
Personal, self-incriminating data that claimants load on social media sites has increased the efficiency of investigations and video surveillance, which have been used for years to secretly record disability claimants engaged in physical activities, several sources says.
“It’s the new video camera,” Pierre Khoury, a special investigator for Harleysville Group Inc., a Harleysville, Pennsylvania-based insurer, says of the social networking sites. “Now we have a new kind of video camera, but we are not actually the ones filming. They are filming it for us.”
Social networking sites increase the efficiency of video recording and reduce investigation costs by eliminating time spent searching for claimants and waiting for them to engage in behavior that contradicts their claim, says Howard Schneider, president of Schneider Associates, a private investigative agency in Thousand Oaks, California.
To start with, investigators lacking a photograph or address to ensure they have identified the right claimant they were hired to tail might find a picture and address on MySpace, Facebook or other sites such as Twitter or Classmates.com, investigators say.
Then there is the listing of physical activities.
In one recent case involving a Los Angeles-area warehouse worker who filed a work-related back injury claim, traditional surveillance of his home proved fruitless, Schneider says.
So investigators found the claimant’s Facebook site and learned about his participation in bowling tournaments and a bowling alley he frequented.
“It just amazes us how much information people provide,” Schneider says.
An investigator visiting the bowling alley found a large banner congratulating the claimant for rolling a perfect game and the date he rolled the game.
“Which was post date of loss,” Schneider says. The investigator video recorded the banner for evidence and later video recorded the claimant competing in a tournament. To do so, the investigator mixed among spectators video recording their friends and family participating in the tournament.
“It was the easiest surveillance we ever had to do,” Schneider says.
It’s common for claimants to load their social networking sites with dates, easing the way for investigators and their cameras to find them.
In another case, a judo instructor who claimed a total and permanent back injury posted the dates and location of his judo classes, says Frank Pinder, president of the fraud and special investigations unit of GlobalOptions Group, an Orlando, Florida-based insurance claims investigation service.
A rodeo bronco rider also posted his competition dates. “We got videos of him riding a bucking bronco when he was not supposed to be able to get out of bed,” Pinder says.
There have been several cases of claimants who play in rock bands in their spare time. The workers list their engagement dates and then provide audiences with particularly physical concert performances, Pinder says.
Investigators provide the evidence for insurers, third-party administrators and self-insured employers, but rarely learn of the claims’ outcomes, they say.
Most of the evidence they collect is used to reject claims rather than to prosecute for fraud, several sources says. Yet some cases are referred for prosecution.
Alternative Service Concepts, a Nashville, Tennessee-based third-party administrator, for example, recently referred a case to Florida prosecutors in which a claimant’s Facebook posting tipped Global Options investigators to his business of selling jerky at flea markets, compromising his workers’ comp claim, an ACS spokesman says.
Social networking sites have become increasingly productive investigation tools because they are being used more by older audiences, Khoury says.
“The 30- and 40-somethings have taken it over and have caused the explosion” in social media use, says Khoury, who is a member of the Baltimore-based International Association of Special Investigation Units and has spoken to the association on the use of social media.
Additionally, Web crawlers and other tools used to scour the postings continually improve, making the sites increasingly productive, Khoury says.
Word of success fighting fraudulent claims is also driving more claims payers and their investigators to sift through social media, Pinder says. His organization dabbled in the practice and then got serious about digging though social sites five months ago.
He hired a technology company to develop a proprietary search tool he calls a “deep Web portal” that allows him to dig deeper into Internet information than “general purpose Web crawlers” allow, Pinder says.
“A lot of people post things they don’t expect the insurance carrier is going to be looking at,” Pinder says. “Their geology hobbies, reunions, bowling, the leagues they are involved in, fishing tournaments, hunting clubs ... pastimes, organizations. Then you can further mine that for information [counter to] their claim.”
Workforce Management Online, September 2009 -- Register Now!
= Member Only
