Workers Compensation Investigations

 

What is Workers Compensation Fraud?

Workers compensation fraud occurs when a claimant, employer, or health care provider knowingly lies in order to gain an advantage, savings, money, or other benefit. While many people believe that workers compensation fraud solely consists of employees lying about or exaggerating their injuries, workers compensation fraud can involve both employers and employees.

What Techniques Do Investigators Use to Uncover Workers Compensation Fraud?

1      Surveillance - Investigators may use audio, video, and other types of surveillance to determine whether an individual worker is as injured as they claim.

2      Interviews and research - Workers compensation investigators may interview colleagues, friends, family, and other individuals to learn whether there is an issue of fraud and, if so, how great.

3     Background checks and records research - An investigation into worker's compensation fraud may include checking medical records, employment records, and other records. Private investigators may also run background checks to see whether a worker has filed numerous compensation claims in the past or if the company has a history of misclassifying employees.

4    Evidence gathering - Workers compensation investigators can gather evidence if they uncover workers compensation insurance fraud. This can help employers and businesses prosecute fraud and cut off workers compensation claims that are not legitimate.

Notable Statistics and Information

Statistics

5      1 in 4 Americans think it's okay to defraud insurers

6       $4.35 million dollars of insurance premium fraud was discovered in 2009

7·       Between 2005 and 2009, $25 billion in disability payments were based on fraud

8      Workers compensation fraud costs the industry $5 billion annually

9      The average household pays $200-$300 extra per year in premiums to offset the cost of fraud

Employee Fraud

10      Injuries with no witnesses

11       Delays in reporting injuries

12      Delays in seeking medical treatment and/or missed appointments

13      Injury while off of work

14     Financial stress at home

15      Filing multiple claims

16     Injury concurrent with termination

Employer Fraud

17       Denial of valid claims

18      Late issuance of disability checks

19       Misclassification of workforce and the nature of work being done by employees

20      Refusal to purchase insurance for employees

21      Making examples of employees who have submitted claims

22     Issuance of 'Ghost Policies' to independent contractors who are actually employees

Do I need a Workers Compensation Investigation?

If you suspect your employee, employer, or a healthcare provider has committed workers compensation fraud, you will need to hire an investigator to conduct and investigation. TEMPLE 57 can help.  Call today at 866.489.3055 or email at info@temple57.com.

John J. Mesa ~ President, PI, PPS