Surveillance and Investigation, Is there any Value to It?

                                    or

        Now that I Have Evidence, Will It at Least Pay for Itself ?

Several articles in this newsletter have dealt with this question directly or
indirectly over the years.  Securing factual information is what surveillance of
a claim is all about.  Factual information to determine how to best adjust a
claim is the key to good claims handling.  Surveillance and investigation is not
solely useful when obvious frauds are identified.  Anyone can see the value in
that scenario, but outright frauds do not happen often.  So why are there several
very successful claims departments using so much surveillance and investigation? 
Because they have learned to use all the factual information in their claims
handling that surveillance and investigation provides.  They have determined a
value for that factual information beyond just identifying the obvious fraud. 
What value and How?

The dollar value savings of surveillance and investigation on claims under
today's laws is very difficult to ascertain, particularly in Worker's
Compensation.  Personal injury liability claims are significantly easier as there
is a specific demand and then either a jury award or an amiable settlement.  In
either case subtracting the settlement or jury award from the demand nets the
value.  Last year, we were involved in a 2.2 million personal injury liability
suit that was settled for $75,000 after the expenditure of approximately $30,000
on surveillance and investigation.  Was it worth it?  Fast math, my favorite
kind, would indicate that the expenditure of $30,000 netted a savings of between
$1.1 million to $2.1 million dependant on whether you wish to factor in the
unlikelihood of the suit having gone full value.  Another personal injury auto
liability case that we were involved in that same year also settled out at
$75,000.  The original exposure was $500,000 and the surveillance costs
approximately $8,000.  Here again, fast math would indicate a savings of between
$175,000 to $417,000 against an expenditure of $8,000.  Personally, I will take
that kind of return on my investment any day.  It should be noted that these
cases were won not on a single surveillance where obvious fraud was found, but
were, in fact, successful because they rebutted the claims of disability point
for point.  Most personal injury cases, whether any of the liability style cases
or a worker's compensation, are won in this manner - Point for Point.

Okay, liability is easy to measure but how does one measure the savings in
worker's compensation cases.  Frankly, I cannot give you the same kind of savings
per case breakdown because I am not sufficiently knowledgeable about each case's
specifics.  I sincerely wish that I could as it would significantly improve my
ability to market my company's services.

However, in Worker's Compensation Claims it takes a professional claims manager
or adjuster to ascertain the savings resulting from no fines and no attorney fees
for having quickly and properly handled a truly injured claimant because any
doubts had been removed by the surveillance which confirmed the injury.  Only the
claims adjuster can ascertain the value from surveillance films shown to a doctor
that nets the claimant's release to light duty when nothing else could.  Only the
claims person can place an discern the cost to the file had the surveillance
films not shown the claimant capable of performing a successful job search.  Only
the claims professional can establish the savings experienced because a physician
deemed a medical procedure un-necessary after having viewed surveillance tapes. 
Only the claims professional can ascertain the savings on his ability to maneuver
a claimant and his attorney into a reasonable settlement because the surveillance
films significantly damaged the claimant's credibility and claims of disability. 
Only the claims professional can place a dollar value savings to the file which
results in the claimant returning to work since all of the doctors, upon
reviewing the surveillance films, released him to full duty.

Only the claims adjuster can ascertain the savings incurred because the
background investigation found the claimant had been injured other than on the
job.  Only the claims adjuster can determine the return to the file resulting
from a Special Disability Fund claim that occurred because the background
investigation found and identified an injury that everyone was aware of but
forgot about.  Only the claims adjuster can place a savings on information that
the claimant is in jail or prison.  Only the claims professional can ascertain
the savings from knowing that they were dealing with a professional claimant.

The scenarios wherein surveillance and investigation saves money in workers
compensation files go on and on.  It really is something whose value is based
upon the skill of the user or claims professional and the broad scope with which
the factual information from surveillance and investigation is used.  If left to
lie in the file or to only serve the purpose of satisfying a file audit that
investigation was done, then there is no value - only expense.  In skilled hands
the dollar value soars and probably exceeds the savings of the personal injury
liability claims spoken of earlier.