Workers’ Compensation Claim
Employers, work site occupiers, claim adjusters and self-insurers use our investigation services to identify fraudulent work-injury claims. We provide detailed reports for each case.
Reasons to engage a Private Investigator
Workers’ Compensation insurance is meant to protect employees who sustain injuries on the job. The insurance typically covers the employee’s medical expenses, loss of wages, compensation for partial or permanent disability, and other expenses incurred as a result of the accident.
While most claims are genuine, there are some who submit fradulent claims in the hope of making a personal profit. Such false claims are a criminal offence. An increase in fraudulent claims would also cause a rise in insurance premiums, which in turn would increase business costs.
Investigations can help minimise the occurrence of fradulent claims. It would also send a clear signal to the culprits and prevent future occurrences.
Types of Fraudulent Claims
Bogus Claim
These usually involve dishonest employees who make false claims for workers compensation payout, or exaggerate a claim in order to get a higher workers compensation payout.
Common examples of false claims:
•Worker sustains an injury outside of work, but falsely claims that he sustained the injury while at work.
•Worker claims he has sustained an injury while performing a job at a particular work site, but had really sustained the injury while illegally performing another job at a different work site.
•Worker exaggerates the extent of his injuries so as to inflate the compensation claim payable to him.
•Worker pretends to still be injured even though he has fully recovered, so that he does not have to return to work for his employer. (In some cases, the worker uses his extended “medical leave” to moonlight for a different employer.)
•Worker pretends to be ill or injured when he is not actually ill or injured. This usually involves an ailment that is difficult to disprove by mere observation (e.g. claiming he has a headache, or a muscle problem in his back or neck).
•Worker claims that an old injury he had has not healed properly (e.g. previous injury to the knee or shoulder) and is preventing him from working, even though it is not true.
Dishonest Doctors and Lawyers
Sometimes, dishonest doctors or lawyers “team up” with the worker to scam the insurance company.
Common examples:
Inflated injuries.
•Doctors may inflate the seriousness of the injuries to the worker, then bill insurers for costly and unnecessary treatments and tests.
Phantom injuries.
•Doctors may bill the insurance company for treatment of injuries that never occurred.
Illegal kickbacks.
•Some dishonest doctors or lawyers hire a runner to refer injured workers to them, on the promise that they can get a better workers compensation payout for the injured worker. The runners are promised a commission for making such referrals (illegal kickbacks).
The Consequences of Fraudulent Claims
Pay higher premiums
•Employers or businesses will eventually have to pay higher premiums for workers compensation insurance when renewing their policy
Reduced jobs and wages
•The worker may lose his job because his employer does not wish to continue employing him due to his “injury”
•Businesses may reduce the number of workers they hire, or reduce the workers’ wages due to increased business costs
There are many case reported that the employee has fraud the claims for personal profit instead of legitimate. The fraud has negative impact to the insurance companies, and the increase of cost of investigation will lead to increase the premium for such services that transferred to the employer.
What is Worker Compensation Plan?
Most of businesses are insured every workers or employee by buying worker compensation plan to cover the accident happen during the course of work. The plan is benefit employee who is get injured in term of of medical certification ( lost wages), medical expenses, treatment expenses etc while the employee recovers from the injury.
Businesses need to be proactive when handling worker compensation claims and prevent false claim by your employee and the injuries person is cover the truth or manipulate the accident.
By hiring Private Investigator, he is a trained individual to handle the false claim and uncover the fraud before the evidence is destroyed.
How is the matter handled by Private Investigator?
1. Interviews and research the cause of incident
•Detail questionnaire to identify the cause of incident.
•record the answer which can be used as evidence in court
•gathering evidence of incident and treatment copies to help detect fraud
•Get the right place to conduct research and collect information
2. Background checks and research
•conduct background check
•checking for any claims in the past
•checking the worker was convicted any fraudulent claim in the past
3. Surveillance
•surveillance the injured worker
•record audio, video or photo to determine the reality of injured.
•surveillance record can be proof that shows the worker has exaggerated the medical conditions
4. Evidence gathering
•Important roles in proving the cases
•evidence is the proof to determine the right amount of compensation
•Private Investigator can intelligently handle the claim and prevent fraud.
