Insurers typically conduct one to three rounds of surveillance, each lasting several days. Professional detectives are hired to capture footage of insured individuals engaging in activities that appear inconsistent with their reported limitations. This strategy aims to challenge the insured’s credibility and dispute their claimed benefits. Surveillance often records brief moments of routine activity or exceptional events, which can lead insurers to question the severity of injuries. For example, if investigators know the insured is moving on a specific date, they might intensify their surveillance, assuming that even someone with significant injuries would be active during such times. They may also focus on brief instances of snow removal, lawn mowing, or enjoying a sunny picnic, attempting to overshadow extended periods of pain and disability.
The impact of surveillance on a client’s benefits eligibility can be significant. In the case of Paicente v. Allstate (22-007952), Allstate sought to reclaim $101,000 in income benefits based on surveillance footage. However, the License Appeal Tribunal dismissed Allstate’s claim, determining that the footage did not prove Paicente was working. This case demonstrates how surveillance can be misconstrued or strategically used to deprive injured individuals of their accident benefits.
Educating clients on the importance of accurate symptom and impairment reporting helps validate their claims and underscores the necessity for honesty. Clients should be advised to consult their representatives and be aware of the potential for surveillance.
To mitigate the impact of surveillance, medical professionals should ensure their documentation is complete, accurate, and reliable. Detailed records of interactions, including specific dates, times, symptoms, and progress, are crucial in strengthening a client’s case. It is important to promptly update records if there are changes in a client’s condition. Recognizing functional abilities and honestly reporting what activities the client can perform, even briefly, provides an accurate representation of their condition. This should include descriptions of the effects when clients push themselves beyond their limits. Using objective language to quantify symptoms, such as noting restricted range of motion or difficulty walking, is essential. Direct quotes from clients about their experiences should be used to accurately capture their emotions and perspectives, and information from collateral sources can offer additional support. If clients report being under surveillance, healthcare providers should request a copy of the surveillance report and footage from the insurer.
While it may not be possible to entirely prevent insurers from employing surveillance during a claim, healthcare providers can take steps to mitigate its impact. By collaborating effectively, medical professionals play a crucial role in supporting injured clients throughout their recovery, especially when surveillance is a factor. Ensuring that documentation is thorough and accurate, and advising clients on how to handle potential surveillance, can help maintain the integrity of their claims. Healthcare providers are essential in presenting a comprehensive and honest representation of the client’s condition, thereby helping to counteract any misleading impressions that surveillance might create.
