Insurance Defense / Sub-Rosa

Sub-Rosa is a term often used in the Workers’ Compensation community, most people do not understand the term or what it means. Sub-Rosa is a Latin phrase meaning “under the rose.”

The rose, a beautiful flower used to express love, is also the symbol of secrecy. In ancient Rome, roses were hung from the ceiling of the great council chamber to pledge the assembly to secrecy. We also see the rose in early Christian symbolism. The image of a rose was often carved on confessionals, indicating that the act of confession between the priest and confessed would remain a secret.

Today the term Sub-Rosa Investigation is used to describe the act of conducting surveillance on a person. Sub-rosa investigation is one of the most powerful tools a claims professional has to document evidence. What’s more damaging than someone caught on video and doing strenuous yard work, when hours earlier they were barely able to hobble into a doctor’s office? Video that catches a subject in unguarded moments will document the claimant’s true physical limitations and can be a powerful confirmation of fraud.

It is the claims professional’s responsibility, after much evaluation, to initiate the sub-rosa investigation. It is important to use a Sub-Rosa Investigator that has extensive experience in this specialty, not a general purpose private investigator, they may not have much knowledge in this specialty. Unfortunately, some adjusters are hesitant to request a surveillance if they’ve had bad past experiences with paying big bucks for surveillance time, with no video evidence to show for it. But if there’s strong suspicion then it’s worth committing the resources to establish a defense.

A Sub-Rosa Investigator will know what is possible within the law. Keep in mind that a Sub-Rosa Investigation involves many complicated issues. Unless you work with an experienced, well-trained, professional, you could end up with unusable video and a blown opportunity.

Documenting Suspicion Of Fraud.

Only employ Sub-Rosa when you have a reasonable suspicion of fraud. Once an Insurance Company or a TPA (Third Party Administrator) has identified and documented a possible fraud, it is the job of a Private Investigator that specializes in Sub-Rosa Investigations to obtain video evidence that will be used by the insurance company, the lawyers and doctors to judge the legitimacy of the claim. It may ultimately be used to reduce the settlement of the claim or used in court to deny the claim.

This type of investigation enables carriers to make informed and timely decisions regarding acceptance or denial of Workers’ Compensation claims. Witnesses are located, statements obtained, detailed reports are provided.

Bilingual investigators are available.

Workers’ compensation is one of the most common types of claims that employers will have to deal with, it can be expensive and frustrating but your Insurance company and a Private Investigator will help you to defend your business from unnecessary costs and complications.

What is workers' compensation insurance, and what is its purpose?

A workers' compensation insurance policy provides covered employees with medical and wage replacement (indemnity) benefits that arise from workplace injuries. Only workplace injuries that arise out of and in the normal course of business are compensable.

Generally, all businesses in California that have employees must purchase a workers' compensation insurance policy from a private insurance company or the State Compensation Insurance Fund. Some large businesses are self-insured and do not purchase insurance policies from an insurance company. For information concerning self-insurance, see thehttp://www.dir.ca.gov/dwc/ Department of Industrial Relations, Office of Self-Insurance Plans at http://www.dir.ca.gov/OSIP/.

Who must have a workers' compensation insurance policy?

Generally, all California businesses that have employees must purchase a workers' compensation insurance policy or be legally self-insured. The WCIRB does not determine who is required to purchase a workers' compensation insurance policy nor does the WCIRB determine whether or not a person is an employee or an independent contractor. For more information, visit the Department of Industrial Relations Division of Workers' Compensation website at http://www.dir.ca.gov/dwc/.

What is covered by a policy?

A workers' compensation insurance policy covers the costs of medical treatment such as physician visits, prescription medications or surgeries. In addition, workers' compensation insurance provides lost time or indemnity benefits. Indemnity benefits are calculated on the basis of an injured worker's weekly wage and determined pursuant to applicable California laws. Your Workers’ Compensation Insurance will also cover the cost of investigating the claim when there are suspicions that have been documented. Employers can hire an Investigator but this is generally not recommended.

SB Surveillance Systems has over 45 years of experience with Workers’ Compensation Claims and will answer your questions and help you navigate the complexities.

In today’s world of Internet, smart phones and instant access to information through various video formats, it is easier than ever to record someone without their knowledge.

Due to its accessibility and the ability to easily use it, video surveillance is often used to assist in various legal proceedings, including defending against personal injury cases. This a Specialty of Santa Barbara Surveillance Company. We use all available data sources and social media for our preliminary investigation.

Gone are the days when a Private Investigator has to use a conspicuous camera to capture footage, allowing insurance companies to use video surveillance more than ever. Many general P.I. websites still use the picture of a smart looking young guy sitting in the front seat of a sedan with a big telephoto lens sticking out of the drivers window! Not only is that not how it's done, it will burn the neighborhood, the Investigator, or get you shot in some parts of town. Never hire a General Investigations firm for a Personal Injury case.

Personal Injury Cases Involving Video Surveillance

Many different types of cases may involve video surveillance. In the personal injury spectrum, video surveillance may be used in cases involving a car accident, truck accident, workers’ compensation cases, slip and fall cases and others. Many personal injury cases involve insurance companies that may ultimately be responsible for paying out compensation to accident victims. Therefore, any case involving an insurance company may involve video surveillance.

When Video Surveillance Is Used

Insurance companies may use video surveillance at different stages in the proceedings. They may use video surveillance in their assessment of a claim. When there are two different stories about how an accident occurred, objective video evidence can be the deciding factor. Claims adjusters may be able to review video footage that was made at the time of the accident to learn about how an accident really happened.

Insurance adjusters may also use video surveillance as part of their investigation. They may record a victim’s conduct after the accident to see whether the victim’s actions after the accident correspond to the claim. For example, if the victim states that he or she is unable to move his or her arms with ease after an accident, the insurance company may try to get recorded footage of the victim lifting groceries from his or her vehicle to contradict the victim’s statements.

Where Footage Is Made

Insurance adjusters must abide by the law. Therefore, they cannot disturb the privacy of the victim in order to acquire video footage, such as by peering through a window. However, insurance adjusters can usually obtain the footage that they desire in a public setting, such as a restaurant, grocery store, park, roadway or other area accessible to the public. There are special rules pertaining to when an audio record of someone can be made, with some states requiring the party to consent to the audio recording before it is made. Therefore, the footage that is captured may need to be audio-less in these states.

Uses Of Video Footage

Insurance companies will use video surveillance to demonstrate that an injured victim can perform activities that they said they could not do or that are inconsistent with their alleged injuries, this footage is often used to dispute liability.

If the case goes to trial, the insurance company can use this footage to show that the victim was fabricating or exaggerating injuries. Such footage can have a direct impact on the victim’s credibility and call into question the entire claim. A skilled Private Investigator will obtain enough videotape and make sure that it is properly documented to be used in court. And with the Investigators foundation it will stand up to cross examination so the videotape evidence will refute and discredit the claim through using video surveillance.

Types Of Personal Injury Claims

Personal Injury is a general term as there are many types of personal Injury claims: Motor vehicle accidents are one of the most common types of personal injury cases. Each is handled by Santa Barbara Surveillance Company from Law Firms and Insurance companies depending on the requirements of each case

Medical Malpractice

Product Liability

Wrongful Death

Workplace Accidents

Premises Liability/Slip & Fall

Animal Bites and Attacks

Assault & Battery

Other Types Of Surveillance

In addition to video surveillance, insurance companies may use other methods to monitor a victim’s actions after an accident. Adjusters may monitor social media accounts for mention of vacations or pictures of the victim performing activities inconsistent with the victim’s alleged injuries. They may also ask questions to neighbors, coworkers and others involved in the victim’s life to try to gather evidence to use against the victim.

Medical Malpractice is a type of Personal Injury claim that can arise from a failed medical procedure or treatment. Sometimes medical devices fail and cause malpractice claims. Drug interactions and side effects can also be a cause. This is a very specialized field of investigation. Santa Barbara Surveillance Company has vast experience in medical malpractice claims.

Monetary gain is a powerful incentive for fraud and unfortunately there are always people who are willing to take advantage of a situation. We have been able to obtain evidence and show if the claim is fraudulent or not, saving thousands of dollars in false claims.

This is another type of Personal Injury claim. Liability arise out of a product failure. All product scan fail and sometimes this results in serious injury. When we Investigate a Product Liability Claim we are looking to determine if the injuries arising from product failure is actually related to the product or maybe caused by other activities. Products can be used in ways that they were not designed causing injury which can be used to defend the claim with the proper evidence.