Social Media and Workers' Compensation Fraud Investigation

Billions of keystrokes have discussed facebook and it's social media brethren and their effects on privacy.  Prior to the facebook phenomenon, people were hesitant to provide strangers their personal information.

With the advent of social media, the script has flipped.  now, many members on these sites provide personal data beyond the scope of most marketer's dreams.

However, one aspect which may be overlooked is how useful the information provided by these sites may be used to target fraud in workers' compensation cases.  Many of us have seen the videos of people shingling a roof while supposedly unable to work or helping a friend move while claiming to be unable to do their normal job due to a work injury.  These videos are the result of usually several days of surveillance by the BWC or an employer.

What usually caused these employees to get investigated in the first place? BWC usually receives a lead from either the employer or an anonymous tipster.  In addition, claimants receiving temporary total compensation may have their social security number run through the state employment database to see if an injured worker is working another job when claiming to be disabled.

Now, some claimants have become their own worse enemy.  with a facebook account and a name, a quick search by an investigator can bring up evidence which will be used against a claimant.  Pictures, employment status, recreational activities... all available in seconds.  Even if evidence of direct fraud may be lacking, an injured worker may hurt his or her credibility if they are claiming permanent impairment while participating in activities which conflict with that claim.

Remember, what personal data you put on the internet may be used for purposes you never agreed to.  If you want to keep your information to a limited number of friends and family, adjust your privacy settings accordingly. 

What Language are Workers' Comp. Attorneys Using?

Many of my clients have entered the industrial commission location and feel as though they are hearing a different language.  When I went to orientation as a new Ohio BWC employee prior to attending law school, i felt the same way.  luckily, they gave us a "cheat sheet" so we had a basic understanding as to what was being discussed.   Here are 7 commonly used acronyms used by workers compensation attorneys, claims representatives, and others familiar with the world of Ohio workers' compensation...

1.  TT (Temporary Total)   compensation paid to an injured worker when he is off work due to allowed conditions in their claim.

2.  FROI (First Report of Injury)  initial form usually completed by employer, injured worker, or physician which provides the who, what, when, where, and how of the work injury. 

3. DHO (District Hearing Officer)  the industrial commission hearing officer who handles first level appeals. 

4. SHO (Staff Hearing Officer) the industrial commission hearing officer who handles appeals from the decision(s) of the DHO. 

5. MMI (Maximum Medical Improvement) treatment plateau where no fundamental change in status of medical condition can be expected within a reasonable probability.  a finding of MMI may stop further TT payments.

6. VSSR (Violation of Specific Safety Requirement)  when the employer violates a safety regulation found in the ohio administrative code which caused the injured worker to sustain the injury.

7. PPD (percentage permanent partial disability)  an award to an injured worker who has suffered permanent impairment due to the allowed condition(s) on their claim. 

How May Temporary Total Disability Payments be Terminated?

How May Temporary Total Disability Payments be Terminated?

There are generally 5 ways an injured worker may have his or her temporary total compensation terminated:


(1) The claimant returns to work;

(2) The treating physician has made a written statement indicating the claimant's capability to return to the former position of employment;

(3) The temporary disability has become permanent;

(4) Work is made available to the claimant by the affected employer or another employer within the claimant's capabilities;

(5) The employee has reached maximum medical improvement.

The practical effect of termination of temporary total disability payments may be absolutely devastating to an injured worker.  More specifically, number (5) may blindside an injured worker because the finding usually comes not from the injured worker's treating physician, but  from a doctor completing an Independent Medical Exam (IME) on behalf of Ohio BWC or the employer.

In most cases, the physician doing the IME examines the injured worker only once.  And often, that exam may be completed in less than 30 minutes.

If the physician reports that as a result of the IME the injured worker has reached Maximum Medical Improvement, a term of art defined under bwc guidelines as "a treatment plateau at which no fundamental functional or physiological change can be expected within reasonable medical probability in spite of continuing medical or rehabilitative procedures", the claim will be referred to the Industrial Commission for a hearing on the issue of termination of temporary total compensation.

At that point, the injured worker has the burden of proof showing that he or she is entitled to continuing temporary total benefits.  If this occurs, the injured workers' best move is to have his or her treating physician review the IME report and provide a rebuttal report.  This is the most effective way for the injured worker to succeed at hearing and keep temporary total payments ongoing.