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
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
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
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 firstname.lastname@example.org.
John J. Mesa ~ President, PI, PPS