In-house vs. Independent Surveillance

In-house vs. Independent Surveillance: Which helps you better manage workers’ compensation claims and keep costs down?

Are you using a third-party administrator (TPA) to control your workers’ compensation claims costs?  If your TPA has their own in-house surveillance staff, it’s important to ask yourself: in whose interest do they provide these services?  Yours or theirs? 
Workers’ Compensation Insurance is a necessary safeguard to protect employees and employers from the high cost of occupational injuries.  The management and adjudication of Workers’ Compensation claims ensures the coverage meets its obligations under the law.  These processes are intended to support the worker financially and medically in times of need and, at the same time, protect the funds from being exploited by unscrupulous claimants. 

When a “red flag” warrants surveillance
Built into most claim processes is the notion of the “red flag”.  These are indicators of potential fraud, waste and abuse and claims staff are trained to react to these flags when they are observed.  Depending on the flag, the injury, the medical progress, and many other factors, workers’ compensation claims might be worth investigating.  Some of those investigations could include placing the claimant under surveillance for a time to help the claims team prove or disprove their functional capacity. 

Surveillance as an ancillary TPA service: Whose interests are served?
Organizations often make concerted efforts to identify and select their insurance carriers or third-party administrators that best serve their needs.  Many TPAs offer ancillary services to support the claim process such as scheduling examinations and treatment.  This can be cost effective and efficient given the deep resources typical of TPAs . 

One such service that is being offered through TPAs is surveillance investigations.  If you are utilizing a TPA that offers this service, you must concern yourself with whether or not your interests are being served. 

In-house surveillance can be a conflict of interest
The TPA has a vested interest in utilizing its own staff.  And when the TPA’s investigator fails time and again, there are no consequences for that failure other than your claim was improperly investigated.  Unrepentantly, the TPA is awarded for the failure and is financially unmotivated to change its practices.  This arrangement is a detriment to objectivity and quality if not an outright conflict of interest.  

Independent surveillance: A better, more reliable investigation
Contrast that with independent surveillance investigators who have a lot more to lose when they fail.  This is because competition is waiting in the wings to step in and take their place when their customer’s expectations are unfulfilled.  Independent investigators are only as good as their last successful case.  And because of the intense competition they can never afford to be complacent.  What this means for the insured is a better, more reliable investigation.

It is for that reason that many insurance carriers, third-party administrators and self-insured organizations now utilize surveillance handled by independent private investigators. These highly specialized investigators spend most of their waking hours observing people while skillfully avoiding detection.  The video evidence they gather can reveal invaluable insight into a claimant’s abilities.  This information helps to better manage claims and keep costs down. 

Consider the advantages of an independent surveillance investigator:

·      Investigative professionals who compete every day for your business

·      Motivation to take the necessary extra steps to close your case

·      Years of industry experience, and ongoing training

·      Impartial observation and documentation 

·      Deeper resources and the latest equipment

 

Want to learn more about how independent surveillance investigation helps you better manage workers’ compensation claims and keep costs down?  

Call Vince Pinchotti for answers at (724) 561-6684 or email him at vpinchotti@csiinvestigators.com