Workers' Comp Investigation Questions

Factual Questions
1

My cousin says he is being followed by (what he suspects) a Workers’ Constipation investigator. On all logical accounts, it’s the only thing this guy could be. He says he parks a few blocks up the street and watches him for a few hours and follows him everywhere he goes. He pretends not to see the guy obviously, but has said that the guy does take pictures with this huge camera.

He told me that his former boss called him and said there was a guy asking if he’s done any work for him since his injury and if so, was there any lifting involved. This has been going on since Halloween. Apparently the investigator doesn’t really care if he’s made or not, because he’s not really discreet.

  1. Can insurance investigators put GPS on your vehicle without your knowledge or approval or without a warrant? I would think not, but my cousin said the guy shows up at the most oddest of places, places where he knew nobody was following him and at the same time, there he is, sitting there with his camera. We just checked all under his truck, but found nothing.

  2. Can my cousin call police and say he’s being stalked? I told him he probably could do that, especially if he feels threatened. I mean, it is odd that somebody is following him around everyday and appears and disappears with the wind.

  3. How much authority do these guys have? I know bounty hunters can do pretty much anything they want without so much as a warrant. But these guys can only do what? Take pictures and follow you around? They don’t really have any legal authority, do they?

I know they can pretty much cause your ass to lose all your comp benefits if you’re doing something wrong, but other than that, that’s it.

2

Privacy laws apply to investigators just like everyone else, but they generally don’t protect you in public.

The precise limits of what an investigator can do will vary among jurisdictions:

http://www.lflm.com/articles/wcn600c.pdf
http://www.gaworkerscomp.com/brasher.htm
http://www.dli.state.pa.us/landi/cwp/view.asp?a=138&q=241839&pp=3
http://www.nixonpeabody.com/linked_media/publications/ELA_03002005.pdf

3

Tell your cousin to have fun with it. In the morning take the guy a cup of coffee. Invite him in as it is cold outside. Complain about how your back hurts.
If your cousin has to go somewhere, have him walk over to the investigators car hop in and tell the guy that he needs to go to the grocery store, and since the investigator is going to follow him anyway, they might as well drive together and save gas.

4

That’s very Tony Soprano-ish.

5

I’d probably get some fake boulders from a theatrical supply house delivered, then let the guy shoot some film of me laboriously moving them around the yard in a landscaping project. If they haul him into a hearing for moving some 2 pound papier-mâché rocks he’ll know what the stalker is doing, and with the receipt and the rocks as evidence he’ll have no trouble getting it dismissed.

6

If a late supper is more his style, he could go the Axel Foley route, though.

7

Of course if he’s legitimately hurt and unable to work, his medical and wage loss benefits will probably be cut off based on the surveillance; he’ll probably have to request a hearing and hope that the hearing officer has as good a sense of humor as you do. If not the hearing officer could just believe the investigator and refuse to reinstate his benefits. Then he’d have to go to court to get them back, and he might lose there, too. :smiley:

8

As an attorney who used to represent employers and insurers in workers’ compensation cases:

There is a good chance your cousin is being investigated sub rosa (fancy Latin for under cover). He has nothing to worry about, so long as he has correctly and faithfully reported his accurate symptoms to the evaluating doctors, and has correctly and faithfully reported to those doctors the way in which he limits himself (if at all) post-injury.

Why do insurers employ PIs for such investigation? Well, there are usually three reasons:

  1. The employer has heard through the grapevine that the injured worker is doing something in his spare time that isn’t consistent with his reported limitations. Mind you, that may not matter too much: if the limitations are prophylactic in nature (which in some states, California included, are sufficient to determine degree of disability), it doesn’t really matter if he is exceeding them on his own time. It only matters if he tells the doctors “I can’t bend over without a shooting pain,” and then is out bowling, and golfing (bending over, not stooping, to pick the ball out of the cup, put the tee in the ground, etc.) and such.

  2. The insurance adjuster is wanting to be a hero. Undercover investigation is expensive. Tell your cousing to feel honored they are willing to pay the cost.

  3. There is an attorney for the employer/insurer who wants to try and justify his existence in the case, so is recommending all sorts of activity, all of which, of course, equates to review and advice expense racked up by said attorney. I had colleagues who routinely advised use of an investigator anytime they got a case, on the theory that it made them look aggressive. Personally, I think it made them look like the typical soak you for money attorney. :dubious:

Now, that’s not to say that such investigation doesn’t have legitimate uses. For example, during a deposition, an injured worker may make statements about the extent of injury which you simply must be able to document are false. Or, you may have solid knowledge that an injured worker is working on the side, while collecting temporary total disability indemnity. But I routinely advised clients of mine that, unless they really knew they were going to get something of significant value from the investigation, they simply were pouring money down a very large black hole.

Now, as to what they can do:

First of all, they know where to find your cousin because people are creatures of habit. They tend to show up at the same places at the same, or predictable times. And just because he didn’t see them follow him to a place doesn’t mean they didn’t manage to do it without detection. Remember, your employer often knows a boatload of details about you, especially if you live and work in a smaller community; it’s amazing what a PI usually starts with when putting together a plan for following an injured worker around.

As long as you are in public, you are pretty much fair game. Tell your cousin it’s like his 15 minutes of fame, and this guy is his personal papparazi. :smiley: Inside his house, of course, is different, but out in his front yard, well, open season.

Wave to the guy with the camera; it always makes the adjuster think the investigator is an idiot. :wink:

9

I’ll echo what DSYoung said. I once had a lengthy conversation with an investigator of Workers’ Comp claims, and he told me stories that would curl your hair about the abuses he uncovered. Example I remember clearest: a guy who had been in an accident but not suffered any visible injury who complained of back pains and received Workers’ Comp payments, videotaped by the investigator climbing a ladder to work on his roof, carrying heavy objects up and down the ladder, etc. You didn’t mention what kind of injury your cousin suffered, but when it comes to some types (especially back pains), the amount of abuse in claims is incredible.

The phony claims cost the companies so much that they’re willing to pay the outrageous prices for lawyers and PIs to investigate.

That means that the idea of lifting paper mache rocks to say “ha ha” is a bad one, as DSYoung points out, unless your cousin wants to spend the money for legal fees to fight it when they cut off his payments. Waving to the investigator sounds like a much better way of showing a sense of humor.

If he’s in fact got legitimate claim, then he really has nothing to worry about. “Since Halloween” is barely a month; if they don’t find anything within about six weeks or two months, they’ll likely back off. Although, depending on circumstances and how suspicious they are, they might show up randomly over the next six months or so.

Of course, that’s all assuming that it IS indeed a PI investigating the injury claim…

10

Ivylad has a WC claim due to an on-the-job injury. He was followed several times at the onset…then I guess they figured after 2 failed back surgeries and the implantation of a morphine pump that he probably wasn’t faking it.

As long as your cousin isn’t trying to scam anyone, then tell him not to worry about it. They’re making sure the payout is justified.

11

There was a documentary about injury claim investigators on TV here. The most amusing bit was when they were following a woman who claimed to have severe back injury. They followed her when she went into a Turkish restaurant. The investigators went in too, sat down as if regular customers and then realised they’d lost her. She was nowhere to be seen at any of the other tables. They sat there for a while before it dawned on them that they were overlooking the obvious: she’d changed clothes and was the belly dancer doing her thing right in front of them, working her way round the restaurant shaking her booty.

12

Yeah, I’m on Workers" comp myself and there is no way in hell would I lift fake rocks. I injured my back, which I’ve stated on here many times, and even bending over is a no-no for me. It even pains me too much to walk sometimes. But thanks for the responses. My cousin worked for the elevator union and fell down and elevator shaft and screwed up all kinds of stuff, plus got a hernia in the mix of everything that needed operating on.

He follows the rules, because, well, he’s injured anyways. It’s just the fact that he’s been getting comped for 5 years, maybe that’s why they’re investigating him? Maybe after so many years, they do it just to make sure you’re not screwing them over.

I tell ya though, the investigator isn’t really a good one, he’s was spotted almost right off the bat by my cousin. lol Maybe he wants my cousin to know. Because if I were an investigator, nobody would make me.

13

How does you cousin know that? Perhaps he was being followed for several months before without noticing.

14

Because he just knows.

15

I asked a friend of mine who used to be a cop and then worked as a PI for many years, in fact he nearly got me started in the business. He said that several weeks of surveillance is pretty expensive for a spec investigation, any case he spent that long on they had some outside information and usually got the evidence they were after. Mind you maybe Aussie PIs charge more.

His favourite was a guy he videotaped changing the engine in his car with the garage door wide open as he hoisted out the old block.

16

Do they investigate people purely at random too? Just as a random check?

17

So where do stalking laws begin? What if I do the same thing the investigator is doing to the OP’s cousin, but I do it to my ex-girlfriend.

I follow her around, snapping pictures of her in public and in her front yard just to relive the old memories. That’s certainly illegal isn’t it?

18

So, to be liable for “stalking” under tort law in California, you have to not only follow the person around, you have to engage in conduct which implies a threat to the person, and the person resonably fears for his/her safety. So, no, in the case you describe, the stalking laws would not be applicable.

19

In general, no; the cost is simply too high to be making random checks.