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Insurance Investigators Mine Social Media to Ferret out Fraud

Insurers are increasingly using social media to track down workers who are perpetrating workers’ comp and other liability fraud by faking injuries or staying on the dole after they have healed.

Investigators are increasingly making use of Facebook, Instagram, LinkedIn and other online social media sites to nab claimants who are fraudulently trying to collect payments. But while social media can be a goldmine of information on claimants, investigators have to act ethically and should do so quickly, experts say.

If an injured worker posts pics of themselves being active on Facebook, it gives investigators quick, actionable evidence for their probes. But that’s only if the images are shared publicly and not just with their friends.

Workers claiming disability payments gift investigators evidence when they post photos of themselves being fit and active on Facebook, for example, but only if the images are shared publicly, experts say.

While insurers are doing their part, employers are also getting in on the action. According to a report in the trade publication Business Insurance, one large grocery chain conducts social media research for auto and general liability claims and other employers research the social media profiles of all injured workers who have workers’ comp lost-time claims.

Many firms have started using social media investigation software that can quickly help them find an individual’s address, phone number and their relatives or associates by indexing sites such as Facebook, Twitter, Instagram and YouTube.

And while many people share their personal information and posts with friends, some post everything publicly. But, by researching the profiles of a claimant’s family and friends, investigators usually can find pictures and other information that has been publicly shared about the claimant on other people’s pages.

While this takes some time, they can usually find recent pictures or videos of anyone using this method, investigators say.

Investigators are also using something called “geofencing.” The practice involves using GPS or radio frequency identification to search for public social media posts that were uploaded within a certain distance of an incident, like a car accident.

Sometimes they are able to locate photos of videos taken by bystanders who have

publicly shared posts. And since most posts on Facebook, for example, use GPS to show location, this can be extremely useful to investigators.

Often, they can even find potential witnesses to an incident.

 

Use with caution

While social media can provide valuable information to prove insurance fraud or abuse, the key is to use this technique ethically. For example, investigators should not dupe someone into accepting them as a “friend” so they can then start rooting through their social media posts.

At the same time, investigators should not try the same tactic with the individual’s friends or family members to gain insight.

That said, if you are looking to control workers’ comp and litigation claim costs, you should add social media investigation into your tool kit if you suspect fraud.

Experts advise employers to index information on claimants’ social media profiles as soon as possible after a claim is filed – and before they can edit their profile.

Also, be aware that many applicant attorneys are warning their injured worker clients to not post on Facebook during their claims.

Thomas Domer of the Domer Law firm in Wisconsin writes: “Use of a Facebook page poses real dangers for injured workers pursuing workers’ compensation benefits.

“Since Facebook is a public site, anything posted can be used by respondent insurance companies in claims denial. Even the most benign postings (birthday parties, family gatherings, etc.) can pose problems. For example, a grandparent lifting a 30 pound grandchild when doctors have imposed a 10 pound lifting limit could damage a claim.”

 

Social media busts
Here are two examples of social media investigations bearing fruit in regard to uncovering workers’ comp claims fraud.

 

The wayward nurse

A nurse in Ohio had filed for workers’ compensation after injuring herself on the job as an in-home care provider. But her employer smelled something fishy and did some research on her LinkedIn page, which showed she was performing the same kind of duties at three other employers as those that had caused her injury.
So, while she was collecting workers’ comp benefits from one employer, she was still actively employed with others. After pleading guilty, she was ordered to pay back the $12,938 that had been paid to her in indemnity benefits – and was also sentenced to a year in jail.
‘Disabled’ worker back on the job

A worker who was collecting workers’ comp benefits from an injury sustained on the job in Ohio was found to be working as a rescue technician for a company in Arizona, thanks to the pictures he had posted of himself on Facebook doing rapelling work.
He pleaded guilty to fraud.

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