Why do insurance companies use Investigators?

If you hadn’t considered this before you can now probably guess this answer.

Private investigators are supposed to be unbiased fact gatherers and are not to ignore any evidence discovered. They should only be concerned with the information needed to evaluate the true abilities of an individual and not try to present a one-sided view of the person they are investigating.

The problem for an injured claimant however is that there is room for “selective” inaccurate evidence gathering. If an insurance investigator selectively chooses the evidence obtained by video or even in the taking of a written statement from the injured person, the investigator may fail to represent the true picture regarding an individual’s physical abilities or accurately represent the full facts and circumstances. 

Investigations usually fall into two categories

First there is the investigator who makes it known who they are and this is usually done as a fact finding exercise and usually soon after the incident that caused the injury.

What should an injured person do in this case? They should contact their lawyer and seek legal advice.

Usually the advice will be that it is not in an injured person’s best interests to provide a statement or volunteer details, however harmless or unimportant they may seem, to an investigator or anyone from the insurance company.

If this happens before an injured person has sought legal advice then that person should seek legal advice first so they are properly informed as to their legal position, rather than provide details without knowing.

The issue is not that the person might want to hide something (which is not an uncommon response by the investigator) but rather that they should get the advice they need to protect themselves. In short the injured person cannot be expected to know the law and by providing unguarded answers could cost an injured person significant sums when it comes to calculating settlement offers down the track.

The second scenario is when an investigator undertakes an investigation secretly.

In these circumstances the subject is usually always videoed so that the images can be presented in Court at a later time.

There are a variety of actions an injured person will or can take if they find out they are being followed, bearing in mind that investigators do not have police powers and that their snooping must be done with the same authority as a private citizen. They must have a good understanding of federal, state laws, such as privacy laws, and other legal issues affecting their work. Otherwise, evidence they collect may not be useable in court.

Some ‘war stories’ of undercover surveillance

Some investigators carry things like loose coins, an oil can, water balloons, a bicycle, a skateboard, and even “tools” matched to a specific claimant and their family.

They then create a “circumstance” that leaves a claimant vulnerable when interpreting the videotaped activity. Imagine the following:

  • Opening your front door and finding a walkway and/or front yard littered with coins (money) to catch an injured person with a bad back bend!
  • Walking to your vehicle and finding you have a flat tire (usually rear passenger side) while away from home, to watch you bend/squat!
  • Having a full water balloon land and splatter a few feet behind you as you walk through a parking lot!
  • Experience a sudden blast from a horn, or someone screaming your name!

All these techniques will undoubtedly provide the necessary positive result, captured as that “one-shot” on video.

Other surveillance techniques involve looking for the injured person’s Facebook page or other social media. The information of the contents of Facebook can then also be exploited and be used against the subject. For example, pictures of holidays, pictures of the subject in a certain position.  

As the injured person is always required to attend medical appointments arranged by the insurance company these surveillance shots are sometimes conducted close to these known medical appointments.

What if the subject discovers they are being filmed? In most cases, an investigator will simply stop conducting surveillance and leave the area, when caught red-handed.

The consequences for the claimant

Most often, hours of videotape are reduced to mere minutes when shown to a doctor (who is retained by the insurance company), the doctor will then write a medical opinion regarding the injury and the level of disability it causes the individual.

What should you do?

The injured person should be mindful of what is happening and make contact with their lawyer. There is no advantage in disclosing to the investigator that they have been caught out.

Should evidence be produced like this in Court or if in cross examination an injured person is asked directly if they can do very specific things (which may suggest they have film of them to show the Court subsequently) is not necessarily a big problem. Sure the injured person may have bent or stretched or whatever on that occasion, but when asked how they felt afterwards the answer may well be that they were in considerable pain.

To sum up

Insurance investigators are here to stay because of the cost in exaggerated claims made to insurance companies. If you are a claimant there is no advantage in providing any answers to an insurance investigator. Should they need to know something let your lawyers provide the answers irrespective of how ‘unimportant’ they may seem.

If you need more information or if you need assistance or advice on how to proceed please call us on 02 9790 7000 or email info@shadpartners.com.au.