Work Injury Claim

Work Injury Claim

TECHNIQUES USED BY PRIVATE INVESTIGATORS WITH WORKERS COMPENSATION AND PERSONAL INJURY CASES REGARDING INSURANCE FRAUD

Workers’ compensation fraud occurs commonly in workplaces where an employer is in a position to compensate or give benefits to an injured employee. It occurs when an employee lies about being injured in the workplace or simply exaggerates the nature of an injury sustained at the office so that they can enjoy the benefits associated with it. It can also be described as the intentional withholding of compensation for an injured worker. Previously, employers would have to investigate these cases without the assistance of an investigator. This involved hiding in alleyways, following employees around suspiciously and more, but now, private investigators have developed tactics to help these employers.

Ways to Commit Workers Compensation Insurance Fraud

Statistics show that the insurance and business industries lose billions of dollars yearly to workers compensation fraud. There are six main ways to classify workers compensation insurance fraud. Here’s some information regarding them:

 

Provider Fraud

This type of fraud usually occurs in providing various services, including medical services, supplies, logistics services etc. It is the intentional manipulation of information to convince an employer that the employee is truly injured or that the injury is more severe than it appears by a service provider. This may include the intentional manipulation of bills or doctoring of receipts.

Employer Fraud

Employer fraud describes when an employer intentionally withdraws an employee’s rights to insurance claims in a case where they have reasonable cause to file a claim.

Worker Fraud

Worker or employee fraud is when an employee falsifies evidence or acts injured or needs the care to gain employment benefits such as insurance, time off work, etc.

Attorney Fraud

This is when critical information is intentionally hidden by the employee and their attorney during a lawsuit to add more claims to their suit.

Insurer Fraud

Insurance Fraud is when an insurance company deliberately alters information when providing insurance to profit.

Claims Adjuster Fraud

This occurs when an insurance agent, organisation, or user, intentionally writes false claims to benefit more from insurance agencies or their employers illegally.

Special Techniques Used by Investigators to Deal with Workers Compensation Fraud

Tactics such as surveillance require particular special methods to remain undetected and effectively prove whether the person under observation needs the worker’s compensation. Some prevalent surveillance methods that have been tweaked are explained below:

Background Checks

The most used method of conducting investigations is a background check. When it comes to worker’s compensation cases, the private investigator looks for specific information, especially from previous employers. Information such as a history of filing claims, prior proof of falsified claims, and previously acquired evidence prove that the concerned individual has committed insurance fraud or similar acts before. The information obtained can help validate the employer’s claims to justify not providing insurance in that case or as proof that the concerned employee is lying.

The Utilisation of Surveillance Equipment

Surveillance equipment such as video cameras, recording pens and other hardware are used to observe the employee. This equipment is commonly mounted in inconspicuous but public places where the claimant might be caught displaying behaviour that does not align with their claims.

Accessing Medical Records

The first record of injury is vital in an investigation. This record helps determine if the affected individual’s claims are valid or not.

Investigators use it to prove the existence of any falsified records after the original injury or if the original documents themselves are false.

Comparisons are made to detect discrepancies in claims and medical history.

Using Social Media accounts

People post a lot of personal information on social media. An employee claiming to have caught the flu at work or broken a limb might harmlessly post a video of themselves vacationing in a cold place, playing with kids or doing something that misaligned with the severity of their injury. This makes it pretty easy for investigators to go through Instagram, Facebook and other social media to check pictures and videos.

Interviews

Interviews involve speaking to people directly involved with the claimant to find out if they have displayed any behaviour that does not agree with the claims that they have made. Some private investigators now confront the claimant without their knowledge and attempt to make them display behaviour that discredits their claim to determine if they are pretending or not.

Employees that are investigated for insurance fraud are usually employees with a history of behaviours that cause the employer to be suspicious of their activity and require them to be investigated. Due to the severity of the crime, such employees if found guilty might be dismissed, or jailed.

 

CSI Security Solutions provides nationwide private investigation services to many organizations and industries on a daily basis. Get in touch with us right away and see how our team of expert PI’s can help you out.

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