The Hartford Works Hard to Spot “Malingerers” and Employers Can Too
Content to Collect
You might assume that an injured worker wants to recover and get back to work as quickly as possible, but that’s not always the case, according to Hartford Special Investigations Manager Odie Waters. Some people, as it turns out, are content to stay home and collect workers’ compensation benefits — long after their injury has healed. This type of fraud, known in the industry as “malingering,” can be difficult to identify and equally difficult to prove. The Hartford devotes considerable resources to stopping malingerers — and achieves considerable success.
Bad-Backed Skateboarder
A 21-year-old employee of a housewares store injured his back moving furniture during his first month on the job. Nearly a year later, he was still collecting benefits. Along the way, he had skipped a physical assessment appointment and walked out of a rehabilitation program designed to prepare him mentally and physically to return to his job. The employer and claims handler became concerned that the young man had no intention of returning to work. The claim was referred to The Hartford’s Special Investigations Unit (SIU) to determine the circumstances.
SIU initiated surveillance and secured video footage of the claimant chasing a puppy, dragging a barbeque grill, and riding a skateboard. His movements were normal for an active 21-year-old. He was not using any visible brace or support, nor did he show any limitation in his movements. Any sprain or strain he may have had from the original injury appeared to be resolved. The investigator shared the video with the young man’s doctor who determined that the young man was ready to return to work. The Hartford discontinued workers’ compensation benefits including payments for further medical treatment.
Doctor Shopping
In the example above, the doctor accepted the injured worker’s claim of lingering back problems. In other cases, the doctor may be less sympathetic. Injured workers who are determined to stay home and collect benefits may engage in a practice known in the industry as “Doctor Shopping.” In such cases, the injured worker repeatedly changes doctors until he finds one who is sympathetic to his claims, even where there is no objective evidence of a continuing inability to work.
“You don’t want the doctor who wants to send you back to work,” says Waters. “You want someone who’s going to tell you what you want to hear — hopefully that your disability is permanent and that you’re going to get a check for the rest of your life.”
The Investigation
Most investigations conducted by The Hartford include a visit to the accident scene and interviews with witnesses and the injured worker if possible. The investigator might canvass the claimant’s neighborhood for potential clues and possibly have conversations with neighbors. Finally, the investigator may initiate surveillance when there is reason to believe that the claimant is engaged in physical activity inconsistent with the medical limitations generally associated with the injury.
The Employers Role in Curing Malingering Injuries
The majority of malingering injury investigations are initiated based on the suspicions of the claims handlers, who are trained to spot fraud indicators. Data mining also plays an increasingly important role in identifying malingering injury fraud.
The employer can also play a role. Often the employer learns of significant information about the claimant’s activities, such as details provided by fellow employees. It might come to a manager’s attention that a supposedly injured employee was out playing basketball, dancing, or skateboarding. If such information raises concerns on the part of an employer, the employer should share these suspicions with the claims handler. After all, if a person can skateboard, that person can probably return to work.