Sixty red flags calling for video surveillance in a Maryland workers compensation claim

What are the 60 red flags that insurance companies look at that lead them to requesting surveillance videos of the alleged injured party in a Maryland Workers Compensation claim or an auto accident claim?

  1. an injured worker who is off on disability benefits who cannot be contacted via telephone during daytime hours; The claimant won’t come to the telephone, is sleeping and can’t be disturbed or is never home
  2. a new claim submitted by an employee who has absenteeism and FMLA issues;
  3. an employee with a pre-existing disciplinary issue pending; The employee is injured after receiving a disciplinary action, demotion, being passed over for promotion or being placed on probation
  4. an employee who may have a personal agenda within the workplace.
  5. Often, co-workers may have information or a sense that a co-worker, who is off on workers’ compensation benefits, is somehow abusing the system.
  6. There are no witnesses to the injury or the only witnesses are the claimant’s “close” co-workers
  7. The claimant and witness statements offer conflicting information Do the statements seem rehearsed or even identical?  Do they both contain the same misspelled words?  Perhaps it’s not a coincidence.
  8. The report of the injury is not timely
  9. The accident report, statements and other documents contain numerous cross-outs, white out, erasures or are incomplete
  10. The claimant cannot recall specific details about the accident
  11. many claimants change details of their statement after inconsistencies have been pointed out.
  12. The injured worker is a new employee
  13. The claimant has a poor attendance record at
  14. The claimant has a history of discipline issues. Employees who have discipline problems can become disgruntled employees.
  15. The accident occurs immediately before or after a vacation
  16. Employees can become disgruntled when their request for vacation is denied.
  17. The accident occurs immediately prior to an employee’s retirement Often the employee will take an early retirement and may even be moving out of the city or state
  18. The employee is injured prior to a strike, company layoff, termination or the employer closing or relocating the business
  19. The employee is injured after giving notice. Nothing says thank you more than an employee who leaves the job and is “injured” during his last few days.  This often happens with employees performing seasonal or temporary work.
  20. The claimant has problems with workplace relationships
  21. The claimant leaves the country for medical treatment
  22. The claimant has a history of reporting subjective claims or has more than one claim at a time
  23. The claimant’s job history reflects a series of jobs held for relatively short periods of time
  24. The claimant’s alleged injury relates to a pre-existing health problem
  25. The claimant is involved in hobbies or sports Claimants injured playing sports over the weekend often attempt to blame it on a work-related injury early Monday morning.
  26. The claimant is involved in home improvement or auto repair activities
  27. The claimant has a part-time job that is labor intensive, i.e. building outdoor decks, installing tile, etc.
  28. The injury occurs on a Friday but is not reported until the following Monday, or the injury happens early Monday morning or at the beginning of a weekly shift. This could indicate the claimant was injured over the weekend.
  29. The incident report and the medical evaluation offer conflicting information
  30. The claimant refuses or delays treatment to diagnose the injury
  31. The claimant misses physical therapy, occupational therapy or other medical appointments
  32. The claimant provides a telephone number but doesn’t live at the address associated with it A variation of this is the “message phone,” where the message taker is evasive or ambiguous when asked about the claimant.
  33. The claimant provides his friends, parents or other family members address or a hotel or post office box in other words the claimant is hiding.
  34. The claimant’s family doesn’t know anything about the claim or they are extremely helpful to the point of the information sounding rehearsed
  35. The claimant is going through a divorce
  36. The claimant is going through a child custody battle
  37. The claimant is having financial difficulties
  38. Tips or anonymous information from relatives or neighbors suggest that the claimant’s injuries are exaggerated or not legitimate
  39. The claimant’s lifestyle is incompatible with his known income These types of claimants have their fingers in all kinds of pies and are usually very active.
  40. The claimant’s family members are on workers’ comp or have a history of claims or lawsuits A family that “claims” together stays together.
  41. The claimant’s injuries are subjective This involves soft-tissue injuries, phantom pain, emotional injuries, etc.
  42. The claimant changes physicians frequently This occurs when the physician releases the claimant to return to work or when his diagnoses is at odds with the claimant’s assertions.
  43. The claimant is healthy, tanned or sunburned. The claimant is obviously involved in outside activities.
  44. The claimant and other workers from the same employer use the same attorney, doctor, chiropractor or clinic
  45. The claimant is familiar with claims-handling procedures or workers’ comp rules. At the very least this could indicate that the claimant has filed a previous claim.
  46. Claimant is exceedingly eager for a quick or discounted settlement.
  47. Claimant lists P.O. box or hotel as their residence.
  48. Claimant threatens to see a doctor or attorney if the claim is not settled quickly.
  49. Claimed injuries are disproportionate to the impact of the accident.
  50. Claimant wants a relative or friend to pick up settlement check.
  51. Claimant will not provide a sworn statement or documentation to confirm loss or value.
  52. Claimant recently purchased private disability insurance policy(ices).
  53. Accident is not the type in which the claimant should be involved.
  54. First Report of Claim differs significantly from description of accident in medical report(s).
  55. Injury was not reported to employee’s supervisor,
  56. Alleged injury reported after termination.
  57. Circumstances of alleged injury suggest employee was not performing regular job duties at time of injury, not supposed to be in the area, or not making full use of available safety equipment.
  58. Extensive history of personal problems, medical problems, drug/alcohol abuse.
  59. Interview of witnesses discloses employee boasted about claiming to be injured in order to collect Workers’ Compensation benefits.
  60. Medical reports in the file do not appear to support the severity of alleged injury.

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