How Often Do Insurance Companies Do Surveillance?

Insurance companies diligently investigate claims that have red flags associated with them. Insurance companies will do their due diligence in determining if an insurance claim is legitimate if there is reason to possibly believe that the claim is not.  Insurance companies sometimes will investigate claims to get a better understanding before deciding on a claim. 

When it comes to conducting surveillance on an individual regarding an insurance claim, it is not about understanding a claim better, generally speaking, it is to determine if a claim is legitimate or not.  With the help of insurance investigators (private investigators), insurance companies can get a better idea as to whether an insurance claim is legitimate or not.

How often do Insurance Companies Assign Surveillance Assignments to Investigation Companies?

There are many considerations an insurance company has when it comes to determining how often they will assign surveillance assignments to investigators.  Generally speaking, most insurance companies do surveillance on claimants with worker’s compensation claims, disability claims, and other claims with injuries. Let’s get into a few of the reasons insurance companies have surveillance assigned.

 Workers Compensation Claim Surveillance

Insurance companies don’t conduct surveillance on every worker’s compensation claim. As mentioned earlier, many times a reason to investigate a claim relates to a potential red flag found within the insurance claim. The read an exhaustive list of workers’ compensation fraud red flags I have written extensively about that here.

Employees That Know They Are Going to Be Laid Off or Fired

There are employees that know they are going laid off or fired for various reasons.  In some cases, insurance companies will find it necessary to have surveillance conducted on a claimant that allegedly gets injured before they are terminated from employment. 

The claimants will claim that they are not capable of doing certain tasks or even working at all in some cases.  The insurance company may investigate the claim to determine if it is legitimate or not.  The surveillance may reinforce to an insurance company that a claimant’s worker’s compensation claim is legitimate or it may reveal concern that someone may not be as injured as stated.

Case Example:

A claimant claimed an injury shortly before he was to be fired (which he knew was coming). The investigator conducted surveillance at the claimant’s residence and documented him for hours preparing to move from his residence. The claimant climbed ladders, walked on his roof, and loaded furniture and boxes into a Uhaul.  

The claimant was followed to his new residence where he was documented again unloading the contents of the moving van into the garage of the new home. 

An Employee May Be Exaggerating an Injury

For various reasons, an employee might have an accident or hurt themselves at work but it is not to the degree they are claiming.  The claimant exaggerates their injury and their time off work lasts much longer than it should.  

An Employee is Double Dipping (Financially)

Some employees again may get hurt and exaggerate an injury or fake an injury to receive benefits while off work but work for their own business or another company.  

Case Example:

An example of this was where an insurance company was tipped off that the claimant had a moving business though the claimant claimed he could not return to work (as a truck driver). The insurance investigator documented the claimant picking up their moving truck from a storage facility, and traveling with two other individuals.  

The claimant became aware of surveillance and the investigator lost contact with the claimant. 

A different investigator was later assigned to the surveillance and was able to videotape the claimant actively working his moving business carrying items to and from the moving truck which contradicted the claimant’s claimed mobility.

Disability Insurance Claims

Disability insurance claims usually are injuries that do not happen in the workplace but prevent someone from returning to work.

Many of the aforementioned examples apply to these sorts of claims.  Claims might be exaggerated, someone might be working secretly while receiving disability benefits when they are not supposed to be working.

Insurance companies may assign surveillance if they have difficulty getting in contact with a claimant.  After all, someone who is unable to work shouldn’t be that difficult to get a hold of.

Insurance companies might assign surveillance on a claimant if a claimant misses numerous medical appointments regarding their claim.

Insurance companies may investigate these claims as well with the use of insurance surveillance investigators.

Slip and Fall Insurance Claims

Slip and Fall insurance claims and claims related to someone falling.  Sometimes these investigations are cut and dry and sometimes they are not.  If an insurance company investigates the claimant and finds potential fraud involved, it is possible that they will have surveillance conducted on the individual with the claim.

If you would like to see a more extensive list of the different types of insurance fraud, you can read more about that topic here. 

How Many Days of Surveillance do Insurance Companies Assign to Investigators?

There are many factors that an insurance company might consider when determining how many surveillance days to assign for surveillance.

Generally speaking, to start off a surveillance investigation, the typical request to investigation companies is to work 2 to 3 days (16 hours or 24 hours).  Sometimes that investigation budget can get used up within 2 days even if 3 days are assigned because a claimant was incredibly active.

A surveillance investigator will continue surveillance until the claimant is no longer active after the 8 hours mark (generally speaking) or until the claimant is lost.

Do Insurance Companies Conduct More Than 2 or 3 Days of Surveillance?

After the initial budget is completed the insurance company will receive the video documentation and investigator’s report that details what took place during the surveillance.   

The insurance company will then decide if more surveillance time is needed.

Insurance companies might ask for more surveillance time if the claimant was not visible for the majority of the surveillance or if what was documented shows that there may be a contradiction in the claim.

Surveillance assignments might continue intermittently for years depending on the insurance claim.  

With large insurance claims that are known to be fraudulent, the insurance companies will spend a great deal of money to investigate a claim as the investigative budget will pale in comparison to the money that would be paid to that particular fraudulent claim.

When Do Insurance Companies Stop Asking for Surveillance to be Conducted?

Insurance companies may stop requesting surveillance be conducted on a claimant when they have enough information to conclude there may be some insurance fraud involved with the claim, when the claim is settled or if there doesn’t appear to be any elements for fraud detected. 

Do Insurance Companies Just Try to Discredit a Workers Compensation or Disability Claim?

As previously mentioned, generally speaking, there is usually a red flag connected with an insurance investigation and that is the reason for an insurance claim to be investigated. Insurance companies are given budgets to work with every year and they must use that budget wisely when it comes to investigating claims.

An insurance investigation usually reveals some potential fraud or proves that the insurance company is paying on a legitimate claim.  If they are paying a legitimate claim there is no reason to continue an investigation. 

I have written more about whether all claims investigated are fraudulent here if you would like to read more about the topic.