Insurance Fraud Investigations
What is a Workers’ Compensation Investigation?
A workers’ compensation investigation examines the validity of a claim. Often times, claimants exaggerate the extent of their injuries or falsify a claim. Workers’ compensation fraud costs businesses billions of dollars each year. An investigation can save money by identifying false claims or third party liability.
Do I Need a Workers’ Compensation Investigation?
A workers’ compensation investigation can ensure workers who file claims are entitled to the compensation they receive. This allows more money to be available to workers with legitimate claims by mitigating losses to employers and insurance companies. If you are concerned with workers’ compensation fraud, a workers’ compensation investigation can help you.
What Techniques are used to Determine Workers’ Compensation Fraud?
- Surveillance – Our workers’ comp private investigators use high definition video and covert cameras to capture footage of claimants engaging in activities contradicting their alleged injuries and physical restrictions.
- AOE/COE – (Arising Out of Employment/Course of Employment) This investigations determine the facts surrounding an alleged injury to a worker on the job and establishes whether the employee’s alleged injury was work-related and happened in the course and scope of employment, or whether the injury was non-industrial or affected by third parties. In the early stages of a workers’ compensation claim, a thorough AOE/COE investigation is crucial in order to determine and document injury-related accident facts before evidence gets lost or memories deteriorate. It is important to document the claimant’s alleged reported injury, along with statements by any witnesses, prior to possible coaching by third parties’ workers’ compensation attorneys.
- Records, Background Checks & Traditional Investigative Techniques – A private investigation into workers compensation fraud may include checking several records to determine whether a worker is truly injured. Background checks verify whether a worker has filed numerous compensation claims or was convicted of workers’ compensation fraud in the past.
- Evidence – Workers’ compensation investigators can gather evidence if they uncover workers’ compensation insurance fraud. This can help employers and businesses prosecute fraud and eliminate workers’ compensation claims that are not legitimate.
- Witness Statements –Oral and written claimant and witness statements can be taken containing accounts of the facts related to a claim. Statements may be taken in person or telephonically, recorded and then a written report is compiled. Claimants and witnesses statements provide evidence to help support and protect the insurance company and business, that will, if necessary, be used as evidence in court. It is very important that the statement is accurate and comprehensive.
- Subrogation – Our worker’s comp private investigators will gather evidence and may discover third party liability, helping to recoup expenses and protect the insurer from paying damages when they are not completely at fault
- SIU – Our Special Investigations Unit are trained insurance investigators specializing in all aspects of the workers’ compensation investigation. Their duties include interviewing, research and analysis, obtaining oral and written statements and taking photographs for evidence. They also safeguard documents and verify public and private records, inspect buildings, homes, vehicles, businesses and personal property.