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Social Media: How is it Impacting Claims Investigations?

Social Media: How is it Impacting Claims Investigations?

Posté par Robin Spaulding le

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Prospective employers have been carousing social media sites such as Facebook, YouTube, Twitter and Instagram to investigate potential employees for some time. Today’s college freshmen are cautioned during orientation to not over-post on these sites, as these postings may come back to haunt them as they begin their post-college job search. The photos from that “fun” night at a local bar when you decided to do 5 shots of tequila after 6 beers may not look so good in the light of day. So what does this mean for P&C insurance companies and how they investigate claims? It means it is a brave new world, and it means it could be ok for a claims adjuster to be on Facebook during the day. In 2015, claimants with a bodily injury claim (Work Comp or Liability) should be the subject of a name search within all applicable social media apps. Want to post a picture/video of your great day of water skiing? Don’t do it after you’ve filed a claim for an alleged herniated disc at the L5/S1 spine segment level. Are claimant attorneys warning their clients to stay off social media? The answer is yes. Are their clients listening? I’m thinking the answer is no.

How did we get here? For many years, P&C carriers relied solely on surveillance to possibly capture an injured claimant embellishing his/her alleged injuries. Here is an example of how this has played out for years:

A tip gets called in by the claimant’s ex-partner or ex-friend. The caller says the injured claimant is skiing on the weekends. The claimant is alleging a herniated disc. Surveillance is hired. Two days and many dollars are spent at a local lake, and there is no sign of the claimant. The next weekend, the claimant was back at the lake water-skiing, but there was no surveillance. In this case, the surveillance failed.

So surveillance results vary. All adjusters know this. While less than 10% of workers comp cases involve surveillance, it is the standard method that P&C carriers use to force settlements or to get physicians to reconsider the diagnosis or the restrictions placed on injured claimants. Many carriers have updated their “best practices” to require a social media investigation of a claimant prior to hiring a surveillance firm. The thought process here is an adjuster should have a credible lead before moving forward with surveillance, as surveillance can cost about $800 to $1,000 a day, and a typical investigation runs two days. So a few minutes spent each day on social media sites is a very cost effective investigation tool when compared to $1,600 to $2,000 spent on surveillance.

Most judges or hearing officers don’t care about nor want to see surveillance videos unless it shows the injured person’s regular behavior. A good day here or there means nothing when adjudicating a claim. However, a game changer can be seeing the regular behavior of an injured person that includes behaviors or actions that are inconsistent with the restrictions from the alleged injuries. Social media is the new gateway to investigating embellished injuries.

Lastly, it is critical to note that the surveillance cannot violate anyone’s privacy or result in trespassing. What one does out in the public or posts publicly is fair game.

Robin L. Spaulding, CPCU, is a former Claims Vice President who is a Principal in the Insurance Practice at Capgemini. She has spent the last 6 years working on multiple successful Guidewire Claimcenter Implementations.

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