The New 1994 Worker's Compensation
                               Law and
                      Surveillance Investigation

As of January 1, 1994, we have a new Worker's Compensation Law
in Florida.  Seems like everyone is trying to determine what
the real effects of the new law are and to their particular
operations.  The legislators and the Governor believe that
they have cured or at the very least significantly improved a
system wrought with abuse.  Personally, I am not qualified to
say whether they have or they have not.  I can only make the
observation that no one individual or group of individuals can
legislate and/or enforce honesty.  My experience performing
hundreds of independent insurance investigations for my
clients, has shown dishonesty and the rewards the system
provides for dishonesty to be at the heart of the abuse of the
worker's compensation system.

If every injured worker told the absolute truth about their
injury, rate of recovery and the degree of impairment
resulting from it, then I would be out of a career and be
looking to see how to get into the managed care industry. 
While the legislator's did severely impact the injured
worker's compensation and therefor the reward for exaggerating
a claim, they did not provide a reward for going back to work. 
Thus there will remain a fairly large number of individuals
who will find that there is still enough financial reward in
the system to continue to exaggerate claims and be less than
totally honest concerning their injuries.

The experience gained from observing claimants and watching
the worker's compensation system at work, indicates that
worker's compensation is to those who abuse it just another
somewhat more honorable social welfare program.  More
honorable because at its base concept is an injury that
resulted from being employed, which is respectable.  However
after seeing and being involved with numerous claims involving
second and third generation claimants, the only observation is
that for many it is a welfare program in a fancier wrapper. 
A teacher friend related the following story.  During an
exercise in what do you plan to do when you get out of school
with juniors in a high school, one young student proudly
stated that he was going to draw.  When queried further about
his artistic desires, he clarified the statement by saying he
meant he was going to draw checks from the government.

So, what do these social observations and soap boxing have to
do with surveillance and the new law?  Some claims handlers
are indicating they are not sure that with the new law there
will be much need for surveillance investigation as well as
several other claim's oriented services.  They feel there will
be less attorney involvement as promised by the legislature. 
My observations are to point out that nothing has really
changed.  There will still be numerous claims filed by
claimants who are less than totally honest about their
condition or the speed of their recovery.  There has not been
a mass jumping out of windows by plaintiff's and claimant's
attorneys or defense attorneys.  Those with whom I have spoken
or seen give seminars are not concerned about their practices,
at all.  Actually, it appears that there will be many more
claimants seeking Permanent Total status than before.
Permanent total is being predicted as the area where the most
litigation will appear.  It also seems that the definition of
a permanent total, is not nearly as well defined and limited
as was originally thought.  The soft tissue back injury
apparently still has a good chance at becoming a permanent
total.

If you are a claims handler looking for justification not to
expend the funds for surveillance investigation of a claim,
then the new law should provide an excellent reason for about
six to nine months.  If you are a claims handler who uses
surveillance and investigation as an integral part of claims
handling then there is even more justification then ever
before for doing so.  You still need to know the truth about
a claimant's injury and the alleged disability.  It is even
more critical under the new law to be able to show video tape
to the doctor and or managed care director, especially since
doctor shopping has been severely limited on both sides of the
file.  Since surveillance investigation reveals the degree of
practical disability, it will be a very necessary part of
claims handling to determine the value of files for settlement
especially since medical can now be settled.

You will still need to obtain earlier MMI dates, return to
light and full duty statuses, lower disability ratings, stop
unnecessary medical procedures and catch total frauds not just
those caught up in the system and exaggerating.  There is
nothing in claims handling that provides a truer more complete
picture of a claimant's disabilities and lack of ability to
function than surveillance where no one controls the setting
or the results.

In the final analysis the worker's compensation system has
progressed to the point where surveillance investigation is
necessary as a routine part of claims handling much in the way
that an IME is nearly routine.  If you are among those
adjusting claims without the benefit of surveillance
investigation, you are possibly being taken advantage of on a
routine basis.