Worker’s compensation (Worker’s Comp) is an insurance created to replace wages or pay for medical treatment in the event an employee is injured on the job. When an employee, employer or a doctor attempt to take advantage of worker’s compensation by lying about a workplace injury, they are committing fraud.
Whether you are an employer who suspects an employee of attempting worker’s compensation fraud or you are an employee who is being erroneously investigated, our licensed investigators will discreetly gather and document the evidence needed to confirm your suspicions.
WHEN IS WORKER’S COMP NOT CULPABLE?
There are situations when an employee is injured in the workplace, but an insurance carrier is not liable to pay benefits. These scenarios may include an injury the employee received when the employee was engaging in horseplay, was intoxicated on the job, or when the employee was attempting to injure himself or someone else.
Another situation falling into this category is an employee who receives an injury while at work from someone who is not employed with a company, and the incident was not due to the employee’s job title or position. Yet another reason could be in an instance of an “Act of God,” except for an employee who is exposed to acts of God regularly as a part of doing their job.
HOW IS WORKER’S COMP FRAUD PERPETUATED?
There are many ways an individual may attempt worker’s compensation fraud. The employee may claim to have an injury that they don’t have. They may have a minor injury, but they profess the injury is more serious than it is.
The individual may claim that a recent injury is still active after it has healed enough for the individual to return to work. Maybe the employee claimed that an injury happened at work, and is receiving worker’s compensation; however, the injury really occurred after work hours. These are all examples of situations in which the employee would not be eligible for the pay-out.
Employers have a variety of ways to illegally reduce the worker’s compensation premiums they’re required to provide to employees. In fact, they may not buy the state-required worker’s compensation insurance. An employer may untruthfully categorize an employee’s job title, they may claim that an employee is an independent contractor, or they might falsify their accounting, and tax records.
In the medical industry, a physician may attempt to bill insurance for more treatments than a patient received, treatments the claimant never received, or phony injury claims.
When someone commits worker’s compensation fraud, everyone pays through increased workloads, manufacturing cost increases, and premiums rise.
UNCOVERING THE TRUTH
An investigator will start with a background check for the purpose of discovering any prior fraudulent activity. That check may include: medical records, and employment history. The investigator may interview colleagues who have witnessed the injury, or the individual’s neighbors for information regarding additional workplaces.
The investigator will conduct surveillance to find out the extent of the individual’s injuries—or lack of them. Surveillance may include tracking an individual on social media such as Twitter, Facebook or Instagram.
Investigators will also conduct physical surveillance tailored to the information they have about the individual. If the claimant is a young person, surveillance may occur in the late evening or on weekends.
If the claimant is a parent of school-age children, morning or afternoon surveillance may be required. During surveillance, the investigator will be looking for any activity that conflicts with injury claims. An example is someone out on worker’s comp for an injured back who is observed shoveling snow or playing at the park with their children.
HOW VALUABLE IS THE TRUTH?
Whether you are an employer concerned about worker’s compensation fraud, or an employee whose rights are being abused, our experienced licensed investigators at Triple “R” Investigations can thoroughly and discreetly meet your investigation and surveillance needs.
At Triple “R” Investigations our expert investigators will quickly produce results using efficient, effective, and reliable methods to support you and solve the case. The truth is worth taking the time to hire a professional, licensed private investigator because they can find the information you need when you need it.
Contact us so that we can provide you with professional, and experienced worker’s compensation investigation.