Conducting surveillance is now more than ever a professional discipline. Jarris Fuller, Queensland investigator and leading authority on insurance surveillance raises some issues worth considering before you instruct your next investigator.

TARGETED SURVEILLANCE

Whilst surveillance is just one of a number of procedures that can be employed in the investigation of different matters, it is a primary tool in the assessment of disability related claims.  The claim usually relates to an injury and/or illness and one of the most effective methods in determining validity is to obtain video evidence of the claimant engaging in activities they allege they can no longer do.  This evidence can be compelling and the surveillance service provider (SSP) needs to consider much when obtaining such video footage.  Disability related insurance claims vary.The claim may result from a vehicle accident (a Compulsory Third Party plaint), a workplace injury or illness (a Worker’s Compensation claim), or perhaps a self-insured injury or illness (an Income Protection claim).  Depending on the type of claim and a combination of the claimant’s personal circumstances, the conduct of that surveillance will often need to be targeted differently.

THE NEED FOR ADEQUATE INSTRUCTIONS
Disability related surveillance instructions from either a claims officer or, in the case of litigated matters, the insurer’s legal representative, will sometimes only provide basic information, such as name, age, address, and type of disability.All too often, the SSP will simply accept the information, complete their observations to fit the budget without further client contact.  Many clients and, in some cases, investigators, do not realize the importance of detailed, comprehensive instructions.  All relevant information about the claimant is important and should be provided to ensure the best possible results. Basic instructions will usually return only a basic result.  The more information available about the claimant, the better the claimant can be profiled and the surveillance targeted to achieve maximum results in a cost-effective manner.

UNREALISTIC EXPECTATIONS
Claims officers and solicitors sometimes have unrealistic expectations. Instructions often require obtaining complex and varied information about a claimant, but will not provide an adequate budget. Realistic budgets allow for a significantly better managed, coordinated and planned assignment.  Targeted correctly, a budget of 30 surveillance hours can produce significantly better overall results than three 10-hour periods, particularly if each of the 10hour operations are over an extended period.  Valuable resources are often wasted relocating claimants.  Flexible budgets provide an opportunity to maximize results in the first instance.

BUDGET RESPONSIBILITIES
However, along with more viable surveillance budgets come certain additional responsibilities for the SSP.  Many solicitors and claims officers have had the unfortunate experience of allocating an initial budget of “up to” a significant number of surveillance hours and the entire budget has been expended when the claimant was found to display seemingly genuine overt signs of their claimed restrictions during the early stages of the surveillance.  With claimants becoming more aware of the possibility of surveillance, their mannerisms often remain unchanged regardless of the perceived condition and unnecessarily prolonged surveillance is a waste of time and money.  There will always be a percentage of both genuine and fraudulent claims, with a percentage of the fraudulent group of claimants simply too well versed in how to beat the system.  If a claim appears genuine, the client needs to know to allow for early settlement, thereby keeping costs to a minimum.  However, if the investigator believes a result can be achieved, but the client is pessimistic, perhaps consideration should be given to a re-negotiated, results-based rate.

PROFILING THE CLAIMANT
With matters involving large quantum, solicitors will often provide extensive additional documentation with their instructions.  This is a valuable source of information and should be carefully reviewed to build an initial profile of the claimant.  The better a claimant is profiled before surveillance is commenced, the better the results.  Then, as the surveillance progresses and new information becomes available, the claimant’s profile is reassessed and further surveillance targeted accordingly.  The preliminary information needed to commence a claimant profile should include the claimant’s sex, age, domestic status, residential address, employment, plus (if known) hobbies and sporting/recreational interests.  In addition, it is helpful to know the type of claim, specific details of the claimant’s injury/illness and their alleged restrictions, plus details of any medical service providers.  Further, consideration will need to be given to the budget and the client’s specific instructions.  All this information is then collated to initially determine what day of the week and at what time the surveillance should be commenced.  All of the available information inter-relates, however, the primary considerations are the type of claim, the allocated budget and the claimant’s injury/illness.  The secondary considerations include all of the other available information about the claimant.  Because there are so many variables for each specific matter, the following examples may provide a better insight into claimant profiling.

THE TYPE OF MATTER
The primary goal of an income protection claim, or statutory Worker’s Compensation surveillance matter is to ascertain whether the claimant is working whilst still receiving benefits.  The secondary goal is to determine whether the claimant is as restricted as they claim.  Therefore, to initially accomplish the primary goal (ascertain employment), surveillance should commence on a Tuesday, Wednesday or Thursday Mondays and Fridays should initially be excluded as possible days taken off.  The claimant’s past employment circumstances should then be reviewed.  For example, tradesmen generally do not work in the rain so rainy days should be avoided.  Tradesmen also often start very early so surveillance starting times should be commensurate with the profile analysis.

THE BUDGET
With a limited budget, preliminary surveillance should target the most likely times the claimant may depart work and be reassessed if there are no departures after several hours of observation. Additional surveillance may then target activities outside of regular business hours, or cover weekends when normal family, domestic and sporting activities are more likely to occur. Larger budgets of 30 plus hours, allow for longer surveillance periods of at least 10 to 12 hours, particularly on the first day.  The reason this procedure is employed is that the longer the claimant is inactive, the more likely they will become active on that day.  However, inactivity for such an extended period is also informative and may indicate several things: the claimant may be genuinely disabled; they may have an unrelated illness (to the claim); they may work from home; they have been sleeping because of shift work, or are they inactive by nature.  If the claimant is active and video is being obtained, it is imperative surveillance is continued on consecutive days to discount later claims by the claimant that they were just having a ‘good day’, were heavily medicated or just put up with the pain.

THE INJURY / ILLNESS
Targeting the claimant’s injury to likely physical activities is also extremely useful.  Activities such as hanging out washing or casting a fishing rod are relevant to a shoulder injury.  The back injury usually targets all general movements.  However, additional insights into physical capabilities can be achieved by, for example, obtaining video on how they get into and out of a car, how they manage stairs, or how they rise from a seated position.  Psychological claims, which may include allegations of depression, stress or anxiety, can also be appropriately targeted by obtaining video of the claimant attending large crowded venues, or showing how they interact with other persons.

OTHER CONSIDERATIONS
Being aware of the claimant’s sex, age, domestic status, residential location, hobbies and sporting/recreational interests can all be of assistance.  Generally, female and elderly claimants are less surveillance aware than younger males.  A 20 year old male is not likely to get out of bed very early on a Sunday, yet mature aged claimants will often be early risers.  People generally get up earlier in the summer months and later in winter.  Claimants residing in a ‘lower class’ suburb are more likely to shop at discount grocery outlets, rather than high-end retailers and supermarkets.  If a boat is sighted at the claimant’s residence and it appears to be used regularly, surveillance should coincide with good weather conditions and promising fishing reports.  Local events such as agricultural shows are also good opportunities for surveillance.  Many suburbs and country towns have strong ethnic links with festivals which can provide opportunities.  Bumper stickers can provide an insight into a claimant’s interests.

CONCLUSION
Good claimant profiling will provide the SSP with a statistical advantage,which will produce better results.  It is not absolute, nor will it guarantee results every time, however, all too often, surveillance is conducted ad hoc, or on a hit or miss basis.  Results can be achieved with this approach, but this relies too heavily on luck.  As a client,would you be happy relying on how lucky your SSP was, or would you rather back the odds?


Jarris Fuller is the principal of Jarris Fuller & Assoc., one of Queensland’s foremost surveillance providers to the insurance industry.  For comments on this article, Jarris can be contacted on 07 3420 3333 or jfamail@JarrisFuller.com.

Reprinted with permission