It’s well known that employers who have STD and LTD coverage with the same insurance carrier see higher LTD incidence rates. There are many thoughts on this:

Ÿ- Only truly disabled employee’s transition to LTD since the STD claims professional has determined they remain eligible for benefits.

Ÿ- Insurance companies make it too easy for claimants to file for LTD benefits.

Ÿ- STD claim volumes are so high that appropriate risk management is not possible.

With leave of absence coverages becoming more prevalent at the state and federal levels, this adds another layer to risk managing these claims.

Carriers continue to see an increase in Musculoskeletal and Behavior Health claims with restrictions and limitations resulting from these conditions sometimes difficult to substantiate. Extensive medical management of these claims can also be cost-prohibitive.

Desktop/Open Source Intelligence Research and Social Media Investigations are a cost-effective and expedient way to assist with identifying possible fraud (unreported income, embellishing severity of injury/illness, etc). Capital’s SmartStart Investigations provides a customized 50+ page report with detailed and specific information to assist with risk managing claims.

A recent review of 500+ SmartStart Investigations found:

Ÿ- 80% of claimants have 3 active social media profiles

Claimants with the most active online presence had the below profile:

Ÿ- Average age of 38 years old

Ÿ- Blue-collar occupation

Ÿ- Diagnosis of soft tissue injury

Results from this specific claimant profile were:

Ÿ- An average of over 50 action photos are discovered

Ÿ- 40% have financial distress red flags

Ÿ- 30% have some form of criminal record

Due to the high volume of claims, STD professionals are often more reactive than proactive, with much of their time spent responding to phone calls and emails instead of risk managing claims. STD claim professionals often lack the experience or training to identify possible red flags.

Let us help by referring a claim for a SmartStart Investigation at: