Using Social Media to Manage and Close Complex Workers Comp Claims

by Curt De Vries / Fraud Sniffr

The purpose of #WorkersCompensation is support an employee while they recover enough to resume the job the were doing when they were injured. For lacerations, sprained ankles, and minor back strains (resolved conservatively in 60 days or less) I completely agree. But what about the dry waller with a torn rotator cuff, or the asphalt worker with a torn meniscus, or the mason with a laminectomy?

Every claim is different and there are more factors to consider than I can address here but the bottom line is the same in all of these scenarios. All of this medical treatment is a repair. Recurring arthritis, ruptures, and fusions are GOING to happen. So what is the best way to resolve?

In my experience, in the absence of a desire to resolve with a C&R by the claimant, a common course of action is “do nothing”. Workers are sent back to work in the hope that they move on to another employer before the repair falls apart or the condition worsens to the point of reopening treatment.

However, that torn meniscus, or rotator cuff repair is going to turn into knee or shoulder replacement and that lumbar laminectomy is going to need a fusion. The question becomes what is better for the insured and its experience mod — let the claim go dormant for a time and risk a significant increase in medical activity or to try to limit the exposure to the company by executing a settlement?

As much as I would like to make a recommendation, the answer is different for every claim given the circumstances. However, to help you evaluate your next move, it will be helpful to gauge the employee’s activity level outside of work now they are feeling better. Social media provides a window into this activity and it is admissible in court (in case that becomes part of the resolution).

Fraud Sniffr provides free updates for the life of claim–the information you need to evaluate whether to accept # RTWFD and close the file or pursue a C&R settlement, and it’s all just a mouse click away.

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#workerscompdefense #socialmediainvestigation #indemnity #permtotal #permtotalloss #insurancedefense