Tag Archive for: workers’ compensation

Unraveling Deceit: How a Private Investigator Exposed Workers’ Compensation Fraud and Infidelity

The Reason You Got Burned: Your Window Tint

So, you’re a private investigator on a stakeout. It’s a bright, sunny day. You’re in your car in a fixed surveillance position, and your fraudulent Subject somehow becomes aware of you, and now your client is upset. Did you get burned because of your window tint?

The Setup

As a P.I., automotive window tints are a must – it keeps you out of view from neighbors, onlookers, and of course, your Subject. And, of course, it blocks visible light from entering your car’s interior.

But before slapping some on your windows, it’s important to know your state’s laws and general info.

Each state has laws for front, backside, rear windows, windshield, and reflectivity.

When you see data on window tint, you’ll see it categorized by percentage.

Here at Gravitas Investigations, we have a rule of thumb: The lower the percentage, the DARKER the tint, and the less sunlight can come into your car. The higher the percentage, the lighter the tint, and the more sun can come in.

tint law rule of thumb

I went ahead and linked to the window tinting laws in all 50 states (click here)tint laws in 50 statesHere’s a handy little US map for the level of tint allowed from front side windows:

Let’s take Ohio, Kentucky, and Indiana, for example, the states where I’m licensed.

In Kentucky, the front side window must be 35%. This means you can’t have a tint that allows less than 35% of the rays on your front side window.

It’s 18% on both the rear side and rear back windows. So you can go darker tint there.

The windshield tint allows you to place a strip of tint to the top of the car manufacturer’s “AS-1” line. What is the as1 line?

as-1

The AS-1 line extends from the “AS-1” label on most motor vehicle windshields. An actual As1 label is found on the windshield and runs parallel to the top of the windshield or at about 5 inches.

Legal window tint in Ohio is at 50% on front side windows. But any level, even limo tint, is allowed on the rear side and rear back windows. So, we can go crazy there.

Indiana legal window tint is at 30%. Legal tint in Indiana for rear window tint is also 30%. Indiana window tint law also says 30% for side windows.

My two cents: if you can, get your rear side and back windows as dark as possible.

Especially if you have an SUV or minivan, when you add dark tint to the rear windows, they don’t seem to change the look of your car that much. That’s because most factory-made large vehicles come with a high level of rear tint as it is. But if you can match the front and back window tint, I tend to go that route.

It’s visually appealing, and it makes your car blend in well.

My cars also have had the 5” band across the top of the windshield. Though some installers won’t put it there if you have a “frit” band. Those tiny little dots around the edge of your windshield.

frit band

I avoid reflective tint because it stands out – it doesn’t blend in too well. I’m not against limo or blacked-out tinting. But if you’re parked for extended periods in your car in a suburban area, it might bring more attention than less.

When it comes to the law, though, I could receive a fine for my tint. I’d be willing to pay that fine. I’ve never been pulled over or cited in my 15 years of driving with an “illegal” tint. I chalk it up to the fact that police officers aren’t looking to cite someone for window tint. It’s a minor offense, and since so many already have it, it’s not worth it for them to stop me.

So, depending on how aggressive your local PD is, it’s up to you how “illegal” you want to tint your windows.

Also, some states allow exemptions. Under some state laws, private investigators can get exemptions on window tinting.

So check your local statutes and revised code for those details.

Quick Tips

Even though you have window tint, the sun can shine, exposing your silhouette.

#1Ensure you angle your car to avoid direct sun glare.

I always like to park with the sun at the back of my car if I can and not blasting through the front window. In cold months, the sun is low and can do that to you.

#2 – Find some shade wherever you park.

When I find a stationary spot and park on the street, I usually try to park where there is an overhanging tree. It doubles the effectiveness of your car’s tint and prevents visible light transmission.

#3 – I always have a front window shade to block out any sun coming in the front window and any onlookers.

I get shades that you can pop in and out quickly into your front windshield.

#4 – In a van or larger vehicle, sitting in the rear seats and using window curtains are huge too.

Passersby only pay attention to who is in the driver’s seat and don’t notice people in the back seat. Curtains block out any silhouette. Also, some minivans come stocked with mesh shades that pull up from the sliding door. So you may not even need curtains on the side windows.

#5 – If you’re renting a vehicle and don’t want to use your own to save on mileage, I always ask for an SUV or minivan.

They come stocked with factory-level side windshield tinting and back window shade. The front windows aren’t tinted, but I assume I’ll be sitting in the rear of the vehicle anyways.

Over to you…

What percentage do you have in your windows? Go ahead and assess automotive window tints for all your surveillance vehicles.

Have you ever been given a ticket for illegal window tint?

Comment below. Let me know.

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The Reason You Got Burned: Driving By Too Slowly

The Reason You Got Burned: Driving By Too Slowly

So, you’re a private investigator on surveillance and you got burned and you don’t know why. Was it because you drove past your Subject’s house too slowly?

The Setup 

So, drive-by video. I learned this lesson early on in my career.

It became ingrained in my brain.

Why?

Because I was assigned to a two-person surveillance operation on workers’ compensation claimant in a rural area of Ohio. Like, we’re talking Amish country people. You’ve got horse and buggy, oxen plowing fields, and epic Amish beards.

But, the reason it was a two-man operation wasn’t that it was so rural, but because the previous investigative team (not from our firm) had been burned on it before.

So, our Claimant was already “heated up.”

And we knew why – the client had provided the previous report and video to us, so we knew what they had done wrong.

This Claimant lived on a country road, and the previous investigators had driven past the house too often, and, too slowly.

Eventually, the claimant, who had a residence with a huge bay window at the front of his house, caught on to the drive-bys.

I mean, he probably knew all his neighbors’ cars as it was, and seeing two cars he’d never seen before drive by every half-hour alerted him.

And this was all in the report – the claimant actually got into his own car and tailed the investigators out of the county.

The Problem

Look, I get it. When you first get onsite to a residence, your natural inclination is to a good establishing shot. You wanna get a shot of the house, the layout, note the plates and vehicles on-site, on top of any action that might be going on.

But that doesn’t mean driving along the road at normal speeds and then all of sudden, dropping it down to a crawl to get some drive-by footage.

That’s a disaster in the making.

So, I’m here to help.

The Fix

First, obviously, don’t ever drive by the house too slowly. There’s no reason for it.

When you do drive-bys, go at a normal speed every time. As if you were an average joe living in the area.

But when you’re shooting video, get the house in the frame early and pan left or right as you pass the house.

Also, while this is going on, zoom in at first and then zoom out wide as you pass by the house to frame everything up nicely.

It’ll take some practice to both stay on the road with one hand and pan and zoom with your camera hand.

The key is to keep it steady. Keep it level.

This isn’t shaky cam footage Jason Bourne.

If you wanna get really fancy you can get ahold of a window mount, one with a suction cup, and fix your camcorder or even a dash camera to the second-row window of your surveillance vehicle.

Press record, do the drive-by, and later edit out what’s unnecessary.

There’s a link below to a mount to get you started: https://amzn.to/2Yh1NWO

Second, especially in rural areas, limit your drive-bys to every hour or so.

You can certainly do drive-bys every half-hour, but only when you feel you need to.

Like if there have been multiple cars coming and going from the residential area, it’s lunchtime for the Claimant, or something similar.

And don’t just come back up the road in which you initially drove down. Give it time.

Driving by the house within a couple of minutes of each other is suspicious.

Instead, drive by the first time and “flank” back to your original surveillance position by going around the “block” assuming there’s another route to get to your original spot.

However, if the residence is in a hollow (like in Kentucky), like a no-outlet street, I’d limit my drive-bys to every two hours.

And, I know what you’re thinking – I could use drone footage or an unmanned surveillance camera hidden in a rock or safety cone to get static video.

Hold your horses, James Bond. That’s a video for another day.

For now, let’s just stick with the basics.

Third, hide your camera.

It may sound simple but what’s worked for me is to actually place my camera hand or monopod on the top of my left arm to stabilize and hide the camera.

I’ll do this if the residence is on my left side.

If the residence is on my right side, I’ll actually place my camera behind the passenger side headrest to get drive-by footage.

These simple methods help to prevent people from seeing my camera through my front windshield as I drive by.

This is me trying to be as casual as possible.

Lastly, and I can’t believe I have to say this but close your windows when filming drive-bys.

If you can’t get the footage because your windows are foggy or dirty, clean those things before getting onsite for crying out loud.

Overall, use the KISS method – keep it simple, stupid.

Drive by the residence like a normal person would (not too slowly!), limit drive-bys to every hour, hide your camera, and keep your windows up.

And, just in case you were wondering. Even with the knowledge of the previous investigation, we still couldn’t get much of anything on that Claimant in rural Ohio. But, at least he didn’t tail us.

Anybody wanna volunteer to take that case??

Over to you…

What ways can you prevent from getting burned?

Comment below.

Workplace Accident Investigations

Workplace Accident Investigations

Many workplaces equate a workplace accident investigation by identifying the party to blame for it. The actual goal of a workplace accident investigation is to prevent its re-occurrence.

While your firm may tackle the workers’ compensation process alone, we believe you better serve your company and its employees’ safety by including a private investigation firm in the total process. Your investigation needs to go beyond the party at fault and make prevention the focus of the investigation.

Accident Investigations and Safer Workplaces

The overarching goal of a workplace accident is to identify the cause of the injuries, followed by developing procedures and processes to prevent future injuries. This process starts with proper evidence collection and information gathering.

Certainly, in the US and Canada, workplace accident investigations form an integral part of legal compliance with Occupational Health and Safety Administration (OSHA) standards. They’re also vital for determining the accident’s cost, to process workers’ compensation claims, and to determine the level of compliance with OSHA regulations.

While OSHA’s focus will center on the incident report and the proper medical treatment of injured employees, your investigation should focus beyond that to the causal factors.

Documenting Process

The quickest and easiest way to administer the investigation is to create and document the process before it is needed. Develop the paperwork and the process formats before their need arises. While the scope of an investigation may differ, the overall process remains the same. A process should remain the same from investigation to investigation to keep the value of any conclusions consistent.

The “Who” in the Investigation

Within your organization, the immediate supervisor of the injured worker should conduct the investigation. The risk manager or safe workplace practitioner may assist, along with any investigative or review committee in existence. Senior management personnel, engineering staff, and the firm’s attorneys may also join in an investigation involving a fatality. During the investigation, you should interview:

  • any injured employees,
  • accident witnesses,
  • witnesses to events preceding the accident,
  • the injured employees’ immediate supervisor unless they’re heading the investigation.
  • The injured employee may have an employee representative present during their interview.

The “What” in the Investigation

The “what” in the investigation refers to the information you collect to determine the accident’s cause and those involved. The data you obtain will later enable your analysis to determine a preventative method for future occurrences. During the investigative process, you should collect:

  •  the employee characteristics such as age and gender, department, job title, experience level, job and company tenure, training records and their hiring status,
  •  the injury characteristics of each injured employee including an injury or illness description, severity, and body part(s) affected,
  •  an events sequence and a narrative description from each involved party and each witness,
  •  characteristics of all equipment involved in the accident,
  •  task descriptions featuring specific characteristics of its performed when the accident occurred,
  •  any factors related to time such as the time of day, placement within their shift, etc.
  •  supervision data such as whether they were under direct supervision or not at all,
  •  causal factors such as the contributing workplace conditions,
  •  corrective actions are taken whether immediate, interim, or long-term.

 The “How” of Your Investigation

The “how” refers to the tools with which you investigate the accident. Having a ready to go kit will help you complete a timely investigation. This kit needs to include:

  •  investigation and interview forms,
  •  barricade markers/tape,
  •  padlocks or warning tags,
  •  camera or video recorder,
  •  voice recorder,
  •  measuring tape,
  •  flashlight,
  •  sample containers.

Having this kit ready to go lets you begin interviewing people immediately after the event occurs. You’ll produce better results by building rapport with injured employees and witnesses. Reassure each person interviewed that you want to fact-find. They need to know it is not about determining fault.

Your full investigation will also include a background investigation that reviews the employment and injury records of each injured employee, as well as, any other party whose actions may have contributed to the accident. Pay close attention to reports of any injuries or damage to equipment, machines, buildings, or property.

Interviewing Techniques

Interview each individual separately. Have each person recount their recollection of the account uninterrupted. Record their response and take notes.

After their recount, ask any clarifying questions needed. Repeat the factual information they said to clarify inconsistencies. One of the key questions you will ask is “What do you think could have prevented this?”

Remember that you need to uncover the causal factors to prevent them from ever happening again. Ask “why?” of those you interview.

Six Steps to Better Investigations

Succinctly, you can sum up a properly administered investigation in six steps. These are:

  1. Handle the immediate risk by obtaining immediate medical help for the injured employee(s). Cordon off the incident area to preserve evidence and deny access. Report the accident/incident to OSHA.
  2. Collect evidence as soon as possible after the injured have been removed for medical attention.
  3. Conduct the investigation interviews as soon as possible. You can interview witnesses while the injured receive medical attention. This immediacy provides the most accurate details.
  4. Analyze your findings. Your analysis develops the corrective actions that will stop it from happening again.
  5. Write your findings report. This summarizes the incident and describes the corrective actions applied to prevent its reoccurrence.
  6. Apply corrective actions. Implement new procedures to ensure the prevention of future accidents. This might include machine replacement or repairs or signage.

 Determining Deeper Causality

Once combined and analyzed, the accident photos, videos, interviews, and physical evidence should lead you to the deeper causality of the accident. Pay close attention to potentially contributing environmental conditions such as weather, light, and noise. Also, examine extenuating factors and externalities.

The accident investigation becomes an opportunity for you to discover an improvement for your company’s business processes. The focus should be on identifying flaws in the process that lead to the incident. It should unearth the reason that procedures were not followed or what prevented them from happening.

Your final report should discuss the contributing, direct, and indirect causes of the accident. Reference data that support each cause.

While your ultimate goal is the prevention of future accidents, a secondary goal is preparation for possible litigation. This is a likely outcome if the accident resulted in severe injuries or fatalities.

The lessons learned from each accident can help prevent larger ones in the future. It’s also important to investigate so that employees and regulators see that your company consistently pursues its commitment to a safe workplace.

Key Questions to Ask

During the interviews, you need to focus on questions that will help you answer larger, deeper issues. Your interview focus should apply queries that help you eventually address the following questions.

  •  Was a hazardous condition or defective tool a contributing factor?
  •  Did the worker’s location or equipment location contribute to the accident?
  •  Did the established job procedure or process contribute to the accident?
  •  Did the employee’s ability to perform the job contribute to the accident?
  •  Did any mandates such as speed incentives or production quotas encourage deviation from job procedures that contributed to the accident?
  •  Was lack of personal protective equipment or emergency equipment a contributing factor?
  •  Did management or a manager’s decision contribute to the accident?

The answers you derive from evidentiary analysis help you determine the appropriate prevention methods to pursue. This could mean a need for new procedures or the need for new equipment. This may also indicate the need for employee education and training or for improved education and training. Another potential result is the need for additional safety gear or to develop or improve protection from natural hazards or phenomena. Finally, it could also point to the need for or improvement of systems to account for possible physical, physiological, or psychological limitations of employees.

Your investigation of any workplace accident should include a background investigation, site investigation, interviews, analysis, and a final report. The aftereffect of the investigation should be amended or new procedures and processes. During your investigation, remember that placing blame is not the reason for your investigation – creating a safer workplace that in the future prevents its re-occurrence is.

While your company could tackle the workers’ compensation process alone, we believe you better serve your company and its employees with a safer workplace by including our private investigation firm in the total process. We help you take your investigation beyond finding the party at fault and to developing preventative measures that keep the accident from repeating itself. Commit to a safer workplace by developing a standardized workplace accident investigation procedure and process. The work you do today results in a safer, stronger workplace tomorrow for all of your employees.

Effective Return to Work (RTW) Programs

Companies of all sizes should have return-to-work (RTW) programs in place. When an injured employee makes a seamless transition back to full duty, everybody wins.

Ideally, RTW programs (sometimes called modified duty, light-duty, and transitional duty) are launched with extensive training in how to avoid injury in the first place. The best time to implement a program is before someone strains a back, takes a hard fall, or inhales toxic fumes.

Still, it’s never too late to put safety first.

The Goal OF RTW PROGRAMS

Workers who were hurt or made ill on the job need time to get up to speed. Good programs help employees ease back into full productivity without reinjury.

During recovery, light-duty jobs are modified to accommodate physical limitations.

It’s true that RTW programs require planning, collaboration, and training. They take time to develop. But, their success is a product of trial and error.

However, companies that design effective programs are never sorry that they did. Boosting productivity, morale and the bottom line always pays off.

Benefits for Employers

The biggest perk for employers is a reduction in Workers’ Compensation costs. According to the Bureau of Labor Statistics, payments to injured or sickened workers approached a whopping $40 billion in 2015.

Injured employees who return to work even part-time collect fewer benefits.

Also, Workers’ Compensation premiums are often the largest expense after payroll. Keeping accidents and injuries to a minimum keeps premiums in line.

Effective RTW programs also limit fraudulent and abusive claims. If your boss were genuinely interested in your recovery and accommodated you with light-duty, wouldn’t you be less inclined to scam him?

Along the same lines, private investigation is rarely called for when employees get back to work quickly.

Even a little productivity is better than none, and retaining good workers saves a fortune in hiring and training costs.

For all these reasons, RTW programs make good business sense.

Benefits for Employees

Continuing to earn income — even if wages are temporarily reduced for light-duty — keeps food on the table. There are also physical and psychological benefits.

Private investigation usually exposes injured workers who attempt to cheat the system, but it sometimes reveals just how isolating and depressing a serious injury can be.

Experts agree that returning to work, even on a limited basis, speeds recovery. Purpose, socialization, and a sense of one’s own value have a positive impact on health.

Making RTW Programs Effective

The hardest part is getting started, but employers who drag their feet could soon find themselves out of business.

It’s a collective effort. If you’re in safety, risk management, Workers’ Compensation or law, business owners and executives could use your help.

Here are some factors that distinguish truly effective programs:

Safety is ingrained in the workplace culture

What does that look like?

The best programs are a valued part of the company culture just like teamwork or work-life balance.

Time and financial resources are invested in safety. Training is thorough and unrushed. Safety is the first item on the agenda of every meeting.

Safety is a condition of employment, and there are consequences for violating rules. Workers are comfortable pointing out unsafe conditions or behavior.

Licenses and certifications are current. There are high standards for documenting injuries.

Not surprisingly, injury rates are low or nonexistent.

Everyone is on board

Management is 100% committed, and workers at all levels know that their superiors embrace safety as a core value.

It takes a natural leader with an engaging personality to make that happen.

Hazards are identified and addressed

New companies identify jobs, equipment, or workspaces with high potential for injury. Older companies review their history to pinpoint the most common injuries and find out how they occurred.

The RTW team brainstorms about ways to protect workers in those positions. Certain jobs may be modified. Safer equipment might be installed. Training may be reevaluated.

This is a great time to ask at-risk employees for suggestions.

Thorough job descriptions are published

Existing job descriptions include duties, physical requirements, and functional requirements such as standing or heavy lifting.

Planners have even thought of ways to convert existing jobs to transitional duty.

For instance, a kitchen steward with a back injury shouldn’t lift 50-pound bags of rice, but there are plenty of onions to chop and potatoes to peel. There may even be bigger fish to fry.

Jobs have also been cobbled together for alternate duty. Ideas include oiling machinery, taking inventory, labeling shelves, answering phones, ordering supplies, making copies, and monitoring security video.

These transitional jobs may be rough sketches, so to speak, but they’re down on paper as possibilities anyway. That shows employees that management will do its best to accommodate them.

RTW-minded managers also consider injured workers for vacant positions.

There’s a designated liaison

A compassionate, organized person who likes working with people acts as a liaison between injured workers, managers, and doctors. Someone who hopes to partner with a doctor is ideal. Third-party administrators (TPAs) can be that solution – there to keep in close contact with all parties and keep the program moving forward.

RTW policies are published and distributed

Company policy clearly defines expectations for both managers and workers. Everyone has a copy.

Workers know how and when to notify the company of injury. Contact numbers are provided.

Employees are familiar with the Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA). Where workers’ compensation is concerned, they understand both their rights and their accountability.

Effective RTW programs are fair to everyone.

Evaluation metrics are in place

RTW coordinators track results – bigwigs in corner offices dig that stuff.

Executives or small-business owners comply with municipal, state and federal laws

Compliance is a lot more complicated than most suits or entrepreneurs know. The importance of working with an attorney can’t be overstated.

The High Cost of Complacency

The cost of keeping workers safe and active is a drop in the bucket compared to the cost of settlements, high turnover rates and lost productivity.

Employers simply can’t afford to be complacent.

Workers’ Compensation Glossary of Acronyms:

Acronyms. SMH.

Having been a private investigator in the Workers’ Compensation (WC) industry for almost 15 years, IMHO, I come across quite a bit of industry jargon – an alphabet soup of acronyms only trumped by the federal government.

If you’re new to the industry, or need a refresher, here’s a list of acronyms YSK:

AOE/COEArising Out Of Employment/In the Course Of Employment
AWWAverage Weekly Wage
BWCBureau of Workers’ Compensation
DOL/DOI/DOA Date of Loss/Date of Injury/Date of Accident
EEEmployee
EMR/MOD RATE Experience Modification Rate/Experience rate used in determining WC premiums
EOREmployer of Record
FROIFirst Report of Injury
ICIndustrial Commission
IMEIndependent Medical Exam
IWInjured Worker
LDLight Duty
LTLost Time
MCOManaged Care Organization
MDOSModified Duty Onsite
Med OnlyMedical Claim Only, No Lost Work Time
MEDCO 14Ohio’s specific Physician’s Report of Workability
MMIMaximum Medical Improvement
NCMNurse Case Manager
PIPrivate Investigator
PORPhysician of Record
PTPhysical Therapy
PTDPermanent Total Disability
RTWReturn To Work
SISelf Insured
SIUSpecial Investigations Unit
STDShort Term Disability
TPAThird Party Administrator
TTDTemporary Total Disability
Voc/Voc RehabVocation Rehabilitation (training to do another job)
WCWorkers’ Compensation