- Surfing the Web for Effective Claim Handling
- April 1, 2009 | Author: James Janarious
- Law Firm: Drew Eckl & Farnham, LLP - Atlanta Office
With the exponential growth of the Internet over the past decade, an immense amount of information is now readily available to the public through relatively little effort. Unlike a library, this information is accessible at virtually any time without leaving one’s home or office. The purpose of this article is to discuss ideas for using the Internet in handling and defending workers’ compensation (or any other personal injury) claims. In my practice, I often use the Internet for three main purposes: 1) to obtain information on a claimant, 2) to research various medical conditions encountered in claims, and 3) to obtain background information on physicians. Below is a discussion of each of its common uses and benefits for claims handling.
1) Obtaining information on claimants/plaintiffs
During a deposition, we typically ask a claimant to list hobbies, daily activities outside of work, and restrictions/limitations as a result of his/her work injury. The most obvious reason these questions are asked is to prepare for surveillance. However, it can also provide a starting point for gaining additional evidence through an Internet search.
In a recent case, we had a claimant with a back injury who admitted to playing golf as a hobby. However, because of the purported severity of his back injury, he testified that he had been unable to play any golf since his accident. Following the deposition, I went to a website that keeps track of golf handicaps; as it turned out, the claimant’s handicap (and the last time he played) was listed on this site. It even showed where he last played. Of course, the last time he played golf, according to the site, was after the alleged accident. The website is located at: http://www.ghin.com.
Another claimant I deposed a few years ago boasted that, before his debilitating neurological disorder, he practiced Karate on a regular basis and was a black belt. It was clear from his testimony that he was still very much into Karate and possibly practiced at a local studio. Since he lived in a relatively small city, I reasoned that there could not be many Karate studios in the area. Consequently, after a relatively quick search on “Yahoo,” I found a website for his Karate studio. The claimant was truthful in his claim of being a black belt; in fact, his name was located prominently on the site, suggesting he was very much active with the studio. Moreover, the studio’s website contained links to other websites, including one that listed Karate tournaments, which predictably noted a past tournament in which the claimant participated (after his alleged work accident).
Other websites that show promise as sources of useful information on claimants are the social networking sites such as Facebook.com, Myspace.com, and Friendster.com. While I would like to claim credit for stumbling upon these sites, this idea came from two of my colleagues at the firm, Lindsey McCall and Dean Dellinger, who have successfully found claimants on Facebook and Myspace. These social networking sites allow a user to post a profile and pictures of themselves (among other information). However, one of the drawbacks to these sites is that the user can place restrictions on the information accessible by the general public. Generally speaking, Myspace tends to be more accessible inasmuch as it has less restrictions than Facebook and Friendster.
A less sophisticated, yet still a sometimes useful method of Internet search, involves simply typing in a claimant’s name into one of the more popular search engines such as “Yahoo” and “Google.” However, unless the claimant has a relatively uncommon name, you will be sifting through a considerable amount of useless information unless you can narrow your search. Nevertheless, I have successfully used this method to obtain helpful information on a claimant.
For example, I learned from an employer in a case that there was a rumor that their former employee/claimant had been arrested as part of a local drug sting. Using Yahoo, I entered the claimant’s name and the name of the local newspaper (in the town where the claimant lived) and uncovered an article on the arrest, which had actually made the front page of this small town paper. Subsequently, I was able to obtain information on the arrest from the local courthouse. When we mediated the claim, this arrest (and the accompanying article) caught the claimant (and her attorney) off guard and provided significant leverage in ultimately settling this compensable claim, even though the arrest by itself would not have been admissible at a hearing.
Once the Internet data is obtained, the question becomes how it can be effectively used in any given claim. One of the most obvious uses is that such information can provide a starting point for surveillance. For example, with the golfing scenario above, if the website indicates that the claimant is a regular golfer who plays around a particular time at a certain course, this could potentially narrow the scope of the surveillance. Similarly, if the web information indicates an upcoming event that the claimant may attend, this could also provide a foundation for surveillance. Consequently, the employer/insurer have a greater opportunity of finding the claimant active with this added information, as opposed to having an investigator wait outside his/her house, hoping for some activity.
The Internet information can also serve as potential impeachment evidence at a hearing. For example, we have used the information obtained off the above-mentioned golf site to impeach a claimant who claimed significant physical and psychological disability from a work accident.
2) Researching Medical Conditions
Prior to the advent of the Internet, participants in the workers’ compensation system, whether adjusters or counsel, had to rely upon searching medical dictionaries or treatises to understand certain diagnoses, causes, symptoms, treatment, and prognoses. These resources, particularly treatises, were often expensive and, more significantly, not written for laypeople. It also takes considerably more time to go through a textbook, even for straightforward questions.
Currently, there are a host of different websites that provide information on most medical conditions. Moreover, several of these websites are designed for consumers, which means they are often free to use, easily accessible, and more easily understood by those without a medical background.
In claims handling, understanding a diagnosis and its common causes is often critical in dealing with issues ranging from causation to treatment. By understanding a medical condition, it is possible to make informed decisions regarding whether to accept a claim or approve certain treatment. Having a working knowledge of the condition often assists in discussing the claim with the treating physician or in preparing questionnaires to the doctor. Simply put, while performing medical research on the Internet will not make someone an expert, it will yield sufficient evidence to make more intelligent claim decisions.
Since a large percentage of claims involve orthopedic injuries, some useful websites I have found include: 1) emedicine.com (which is affiliated with WebMd), 2) spine-health.com, and 3) orthopedics.about.com. Obviously, this is not intended to be an exhaustive list, but reflects some of the more popular, comprehensive, and well designed sites I have found through the course of claims handling. For more sophisticated searches that include links to abstracts from medical journals, ncbi.nlm.nih.gov/sites/entrez is an excellent site.
3) Researching Information on Doctors
The authorized treating physician can either assist in bringing closure to a case or wreak havoc in a claim. Therefore, it is well-advised to research a doctor’s background prior to including him/her on a panel or agreeing to a change in physician with opposing counsel. Once again, this is an example in which the consumer has several tools at his/her disposal for researching a physician. By far, the most useful site I have discovered for obtaining background information on a doctor is the Composite State Board of Medical Examiner’s site, at medicalboard.georgia.gov. On this site, there is a link entitled “Look up a licensed provider.” This site is excellent for several reasons. First, it provides a thumbnail sketch of a physician’s qualifications, such as where he/she went to medical school, residency, and practice area. It also indicates whether the physician is board certified in any specialty. Second, it also indicates whether the Board of Medical Examiners has disciplined the physician under the section entitled “Public Board Orders.” In a recent case, I discovered such a disciplinary order against a claimant’s IME physician, which provided very useful impeachment evidence when I deposed the doctor.
Third, the site offers other useful information such as whether the doctor’s license is current, hospital privileges, medical malpractice settlement amounts, and other languages the physician speaks. It should be emphasized that a majority of the information on the site, with the notable exception of the public board orders, is self-reported by the physician; in other words, the physician is the source of the information, so it is well advised to verify the data. For example, it is possible to verify a physician’s board certification at the following website: www.abms.org. Another excellent site to cross-reference is the one maintained by the American Medical Association at: webapps.ama-assn.org/doctorfinder/.
Conclusion: Exercising Caution with Internet Information
Being familiar with the Internet and the information available to the general public will often assist in effective claim handling. However, there are certain important caveats to its use. First, while the information obtained may provide useful impeachment evidence, the evidence must obviously conform to the standards of admissibility under the Civil Practice Act, which would encompass an entire article onto itself. Second, information obtained off of the Internet needs to be examined for completeness and accuracy, which is part and parcel of why it must adhere to the standards of admissibility. For example, the on-line encyclopedia known as wikipedia.org is touted as the “free encyclopedia that anyone can edit”; this presumes that the “editor” knows his/her information and thus, supplied correct data. Third, as a practical matter, it is well advised to refrain from contacting a claimant through the Internet (which is possible through such social networking sights like Myspace and Facebook), particularly if the employee is represented. By keeping these caveats in mind, astute use of the Internet can provide positive results in a claim.