Being monitored by an insurance company is less common than many claimants expect. In Queensland, surveillance only occurs in a fraction of compensation claims. Suspicion of fraud or where an insurer has reason to believe a claimant is exaggerating their symptoms is the most likely reason surveillance is conducted.
Why will an insurance company begin surveillance?
If your medical condition, the symptoms you experience, and the restrictions you say the injuries impose upon you functionally both at work and socially are accurately reported, surveillance presents no real risk to you. Its purpose is to confirm whether the extent of your injuries is consistent with what has been reported to medical practitioners, independent medical assessors, and claimed in the claim documents generally. Surveillance may be used across all Queensland personal injury claim types including WorkCover, Compulsory Third Party (CTP) motor vehicle accident, public liability, and Total and Permanent Disability (TPD) claims.
What raises suspicion?
Surveillance is most likely to be conducted when medical evidence in the current damages claim conflicts with other reports, medical records or reports from unrelated claims, and such conflict raises questions about the limitations a claimant has claimed and reported.
One example involves pre-existing injuries. If a claimant was in a car accident and was not injured but is trying to claim for a pre-existing condition or injury, this inconsistency may surface during routine investigations. This could then prompt closer scrutiny.
Another scenario is if a claimant’s injuries are seemingly exaggerated and there’s evidence that they have been completing hands-on duties or other activities inconsistent with their injury, the symptoms complained of or statements made in claim documents.
Surveillance standards
There is very limited regulation around the circumstances when insurance companies can undertake and then use surveillance. Taking CTP claims as an example, the Motor Accident Insurance Commission (MAIC) Claims Management Standards state an insurer may conduct surveillance if any of the following applies:
- based on available evidence, the insurer reasonably suspects the claimant is exhibiting or providing misleading information or documents in relation to a claim
- based on available evidence, the insurer reasonably suspects that the claim is inconsistent with information or documents in the insurer’s possession regarding the circumstances of the accident or medical evidence
- based on available evidence, the insurer has reasonable grounds to suspect a claimant of fraud.
For other personal injury claims, the Personal Injuries Proceedings Act 2002 (Qld) governs proceedings. The lawful collection and handling of personal information gathered through surveillance is regulated by the Information Privacy Act 2009 (Qld) and the Federal Privacy Act 1988.
When is surveillance most likely to begin?
If an insurer does decide to conduct surveillance, it can begin at any time a claim is lodged, but in practical terms it would more likely be after independent medical reports have been commissioned by the claimant. Common triggers include the circumstances detailed above under ‘What raises suspicion’, namely significant inconsistency between independent medical reports, inconsistency between medical evidence and reported daily function, or sometimes simply the size and value of the claim.
What surveillance is legally permitted?
In Australia, insurers are permitted to conduct desktop surveillance of social media accounts, or direct surveillance from a public place. It is unlawful for an investigator to trespass on private property, access confidential government records, or take photographs of you in a private setting, but any claimant should be extremely vigilant at all times.
How you can protect yourself
The most effective way to protect yourself is also the most straightforward: be honest and consistent with how you describe your injuries, the symptoms you experience and the restrictions you face from day one of your claim. Be mindful of what you post online and assume your social media profiles may be reviewed at any point.
Don’t put your life on hold more than you are advised to by a medical professional. Follow your doctor’s recommendations for treatment, restricted activities, and activities you have been cleared to continue. Maintaining the activities your doctor approves is often important to both your wellbeing and your recovery.
Your lawyer will guide you through the process and help ensure your claim accurately reflects your circumstances. Get in touch with our team for a free case review today.