Detecting a fraudulent claim of workers’ compensation begins with an employer or insurance company becoming suspicious of the claim. There are certain classic red flags of fraud. For example, the injury was alleged to have happened right before or right after a weekend or holiday. It is common for people to have a real injury, it simply did not occur at work, and it is therefore not eligible for compensation.
Did the injury happen on the job?
If you have a suspicion of fraud, we can investigate to determine how and where this injury was likely to have occurred. If it happened at work, there should be some evidence. We can interview other employees to find out if the injury is likely to have occurred on the job. In addition, we can investigate what the employee was doing on their days off. If, for example, they went to a ski lodge for the weekend, there may be physical evidence, as well as witness testimony, that indicates the injury occurred while skiing and not something that happened at work.
In many situations, the employee is faking the injury. If this is the case, you will not likely be able to detect fraud. At least not in a way that will lead to having the claim rejected. We offer the service of surveillance. If after reviewing all of the information we believe there is a high degree of probability that the employee is faking the injury, we can place them under surveillance. This is all done legally, and in the open. We can record people in places where they do not have an expectation of privacy. However, when they are away from work, they often let their guard down and do something physical that is not possible given the particular injury they claim to have.
Sometimes the most difficult claims to debunk are those involving two or more employees who conspire to commit workers’ compensation fraud. There are witnesses that the injury occurred at work, but they are lying. It is possible for an investigator to go undercover, posing as a worker, and discover the conspiracy. A professional private investigation firm, such as ours, is able to this both legally and effectively.
It is not only about saving money
Preventing fraud with workers’ compensation claims can help save your company money by keeping your premiums down. For an insurance company, the fewer fraudulent claims that are paid out will contribute to a company’s financial health. However, keep in mind that fraudulent claims are also criminal, and our investigation is also about bringing people to justice. Sometimes our evidence of fraud is strong enough that we simply turn it over to the District Attorney’s office, and let them decide how to proceed. When faced with criminal charges, many fraudsters will confess.
You can contact us today and tell us what is making you suspicious about one or more claims of workers’ compensation. We can let you know the services we provide that will help you in your specific circumstances.
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