Angry Employees

Services Private Investigators Can Provide When Employees Pose a Threat

Cornered and Scared

Employees can get backed into a corner when their perception (true or false) is that they are going to lose their job or are going to be disciplined from an employer.  People react differently to adversity.  Some do well and handle tough news appropriately.  Others yell and argue but it is really just barking without the bite.  And then there are others who perceive a great injustice befell them through no fault of their own.  These may be the employees who pose a threat to the company and their co-workers.

Who are these people? 

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Socially, these people may be perfectly functional.  They are able to get along with others and may even be leaders.  But just below the surface lies a crippling character flaw.  This flaw leaves them fragile as a result of rejection of one sort or another.  They basically cannot handle what life throws at them.  This trait was recently on display in California where a troubled young man evolved into a mass murder.  By his own admission, his ego could not handle being rejected by females and as a result, he could not cope with it.  This is certainly one of many factors of his personality but probably contributed to his actions.

The big clue

Of course this is an extreme case of violent reaction and there is no doubt about this person’s historical mental trouble.  However, there is something to learn from active shooter behavior which could benefit business leaders when trying to discern dangerous employees.  While there is a continuum of fragility and a person’s capacity to act out, one key to look for is an enduring and consuming grievance they are dealing with.  This trait is manifested in an escalation of behavior which can be detected if you are tuned in.  Suffice to say, the biggest clue is that these people often broadcast their intentions prior to causing problems.

Semper Paratus (Always Ready)

While it can be scary to think that you may have someone capable of murder lurking within your ranks, it should be pointed out that the probability of workplace shooters remains low.  While you should always consider this possibility, know there are more frequently occurring types of violent behaviors which work place managers must contend with.  These risks need to be addressed as both a probability and a reality.  Training, preparation and consulting with professional help when developing plans of action are always recommended.

Help is available

Here are come common services provided by professional investigators to companies that suspect potential employee violence or disruption when termination or discipline is dispensed.

• Background research – This passive option is used to find out what may be lurking in public records or in social media that may provide insights into motives and potential behavior.  
• Investigation – This active option is often overlooked. Talking with the subject, his co-workers, family and neighbors may best be handled by someone representing the interests of the company.  
• Security presence – Having security on-site at critical junctures, either overtly or covertly can provide peace of mind and confidence for those company officials carrying out the necessary actions.  And if something does go awry, the protection is there, just steps away.  
• Surveillance – Often, after an employee is let go, his actions are observed for a few days to make sure he is not planning on coming back to cause chaos.  
• Executive Protection – This goes beyond the protection of company executives but may may also be extended to their family members if the situation is deemed serious enough.  
• Police Liaison – Coordination with local law enforcement is enhanced by professionals who know how to communicate in the language police speak.  It also frees the company to concentrate on the business side of things while receiving concise updates of police activity or requests through the investigator.    

Disability Event Horizion

Communicate changes that impact your client as part of your anti-fraud protocols  

NY’s Finest Scammers 

It was recently reported that New York City Police and Firefighters were caught defrauding Social Security Disability Insurance benefits.  The disabilities being claimed were psychological in nature and many blamed the trauma they suffered was a result of the September 11 terrorist attacks. Several claims were investigated and 106 people were found to be involved in the scheme.

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The claimant’s were caught through the use of traditional surveillance and through observation of their social media posts.  The information gathered through these channels revealed their claims were not only invalid but also potentially fraudulent.   This allowed the investigators to deny the benefits and to charge the group with various levels of larceny.

A vulnerable system

Private disability carriers who have full time Special Investigation Units and ongoing anti-fraud training are typically well prepared to ferret out these scams. As for the SSDI, the Office of Inspector General is charged with protecting these funds.  But because the program is so large, it is hard to police.  Hearing about a scam that was discovered involving the SSDI fund is not that common.  Because it is hard to protect, the fund is vulnerable to fraud by the unscrupulous; including organized criminals.

In this case, it was clear that coordination was a part of the formula to defraud.  Leading this scam were a group of “advisors” who directed the claimant’s behaviors in an attempt to make their bogus claims believable. These “coaches” received kickbacks from the claimants in exchange for their advice. This strategic configuration to illicitly harvest funds from the trust fund is by definition organized crime.

What brought this case together though, was the cooperation between the Office of Inspector General, the NY district attorney’s office and their relationship with police and fire internal affairs. What forced this alliance was the exploitation of an event (9/11) and the PTSD it caused.  Or in this case, allegedly caused.

It’s different when businesses protect money

Private disability carriers also utilize surveillance and social media research to identify claimant behaviors that might be incongruent with their limitations and restrictions.  While these tools are powerful, it is the keen observation of the claim manager that is critical to the discovery of red flag indicators in a claim.  

Claim managers have the most intimate contact with the file and the claimant during the life cycle of the claim. As such, it stands to reason that they must receive comprehensive and consistent anti-fraud training to ensure suspect claims are identified.  However, for good anti-fraud efforts to work, it is  important that these critical employees see the bigger picture.

Flow of information is key

While private disability carriers or self-insured’s might not experience a scam as large as the one identified in New York, the potential exists for several claims to be filed related to a specific event experienced by a client- akin to the mass PTSD claims caused by 9/11.  

When these changes or events become apparent, it should be top of mind for claim professionals to communicate this information throughout their organization, especially to claim managers who are on the ground floor.  For instance, if a client announces that a plant is closing, the claim managers should be made aware of this as employees might file disingenuous claims in an attempt to extend income during a layoff.

Turn information into wisdom

Keeping a keen eye out for events that impact businesses you insure is a wise and healthy thing to do.  But keep in mind this information is not just useful to those in upper management.  Recognize how important this type of information could be to your front line employees.  In summary, keep in mind the following tips:

1. Anti-Fraud training should include fostering awareness of the client’s business situation.  
2. Claim managers need to be made aware of the changes to client’s status so that they can react appropriately to claims.
3. Claim Directors and above need to take it upon themselves to not only inform the claim managers of a change or significant event a client experienced but also demonstrate what that change might mean to claims and claim operations.
4. Be aware that weaknesses caused by changes my be exploited by coordinated efforts.
5. Know that incentives for third parties can influence claimant behavior.  

Don’t have an SIU?  Contact CSI for professional claim investigations and anti-fraud training.

Self-Insured Companies Might Be Ahead of the Curve

Insurance Industry Financial Challenges Provide Opportunities for Companies to Save Money

Rising Costs: A Sign of the Times

Business owners know that rising insurance costs are part of our daily conversation.  Factoring this into the algorithm that computes the bottom line is a variable like no other.  The upward trend is real and understanding why it is climbing deserves our attention.  A white paper by Forbes Insights released in September of 2013 addresses several reasons why rates are rising and not surprisingly, they are complex and intertwined.  Fortunately, there are strategies to help mitigate these costs but understanding the basic causes may help you find the greatest savings opportunities.  

Challenges Faced by Insurance Companies 

For insurance companies, the days of relying on investment income to support operating costs and earnings are long gone for now.  As a result, pricing discipline, which has been lax in the past for the sake of market share, is back in vogue.  That means a focus on underwriting which necessitates higher premiums for consumers.

The trend toward higher premiums is predicted for some time.  The impacts of recent governmental regulation coupled with a weak economic recovery will take awhile to play out.  And even when the rate of investment returns does increase, the payoff for insurers is a long way off.  

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Another financial challenge for the industry is the rising cost of healthcare. This is acutely felt by property and casualty insurers in the worker’s compensation marketplace.  Statistics reveal the cost of medical care has risen over 380% since 1981.  Since this rate outpaces other costs, the disproportionate medical fees are forcing insurers to stabilize their finances by passing this on.    

Industry insiders also observed that claims tend to be extended during a weak economy.  In other words, when there are fewer employment opportunities available, people remain on claim longer.  This trend raises litigation costs as well as settlement costs for insurers as they have to work harder to get people off of claim. 

Conditions Create Opportunity

As premiums rise, consumers of insurance products will be looking for alternatives.  Some companies will also move away from traditional insurance and explore becoming self-insured.  This move, however, will force these companies to take a hard look at their own risk management practices in an attempt to lower their exposure characteristics.  

Self-Insured Companies Stay Ahead

As it relates to risk management, CSI has many self-insured companies as clients.  In particular, CSI’s surveillance division helps self-insured businesses resolve their Worker’s Compensation claims.  For many of our clients, we have become an integral part of their insurance risk management team.  Here are some observations of what a mature relationship looks like when we partner with our self-insured clients.  

1. They ensure that their claim administrators have an anti-fraud, waste and abuse (FWA) plan. 
2. They ensure their claim managers know red flag indicators of FWA and how to react to them.  
3. They are prepared to protect their fund from FWA by investigating suspect claims. 
4. They trust our expertise in surveillance operations and expect us to maximize their investment in resolving the claim.  
5. They understand that surveillance is just one tool used to investigate the legitimacy of claims and/or the actual condition of the claimant.
6. They know that fraud is determined in a court of law and not in a claim office.  
7. They only use surveillance results to evaluate the merits of the claim.  
8. They treat surveillance results as being highly confidential and only the people who need to know have access.  

We find that our best self-insured clients have chosen competent administrators who manage their fund.  We also note that these companies are genuinely concerned about their employees’ well-being and are aware of claim outcomes.  However, they also set the tone that abuse of benefits will not be tolerated.