Worker’s compensation fraud is a tremendous issue in the United States, costing businesses 30 billion dollars every single year. This type of fraud can take many different forms, from employees claiming to be injured when they are not, to filing false claims for medical expenses or lost wages.
In order to protect your business from worker’s comp fraud, it’s important to understand what to look for and how to investigate fraudulent cases. At Forefront Investigations, we have years of experience conducting worker’s compensation investigations and helping businesses recover significant losses due to fraud. As a result, we know exactly what to look for and how to get to the bottom of a potential fraudulent case.
In this article, we share some of the most common types of workers’ compensation fraud we’ve witnessed over the years. And, to ensure that your business is protected, we also discuss how hiring a private investigator skilled at conducting workers’ compensation investigations can help you dissect and prevent fraud at your corporation.
Let’s get started.
Common Types of Workers Comp Fraud
From our experience conducting workers comp investigations, we’ve seen many different types of fraud. Some of the most common include:
Employees claiming to be injured when they are not
This is perhaps the most common type of workers’ compensation fraud. An employee may claim that they are injured and unable to work, when in reality, they are perfectly healthy. In some cases, the employee may even fake an injury by deliberately hurting themselves at work.
Filing false claims for medical expenses or lost wages
Another common type of workers’ compensation fraud is when an employee files false claims for medical expenses or lost wages. This can be accomplished by doctor shopping to find a doctor who will give them the diagnosis they need, or by falsifying medical records.
Working while on disability
Some employees may try to cheat the system by working while they are on disability. They do this by starting their own business, working for cash, or working for another company while still collecting disability benefits.
Hiding pre-existing conditions
In some cases, an employee may try to hide a pre-existing condition from their employer in order to get workers’ compensation benefits. This can be something as simple as not disclosing a previous injury, or it can be more elaborate, such as getting surgery before starting a new job.
Exaggerating the extent of an injury
When an employee claims to be more injured than they actually are, it’s called malingering. They may do this to get more money, or to stay out of work longer.
Returning to work or performing other activities while still collecting benefits
This type of fraud occurs when an employee is still collecting workers’ compensation benefits, but has returned to work or is performing other activities that they should not be able to do based on their injury.
Injuries that occur outside of work
In some cases, an employee may try to claim that an injury occurred at work, when it really happened outside of work. They’ll often do this if they don’t have workers’ compensation insurance, or if the injury is not covered by their policy.
These are just a few of the most common types of workers’ compensation fraud we’ve seen here at Forefront Investigations. But believe us when we say, we’ve seen it all. Employees have a distinct ability to be creative when it comes to cheating the system!
Signs That Indicate Worker’s Compensation Fraud
When conducting our investigation, there are a few key signs that we look for that may indicate workers’ compensation fraud. These include:
- The employee has a history of filing workers’ compensation claims – This could be a red flag, especially if the claims are for similar injuries.
- History of drug use – This could signify that the employee is using drugs to self-medicate for a pre-existing condition or injury.
- Living beyond their means – If the employee’s lifestyle doesn’t match their income, they may be receiving income from somewhere else.
- Vague about the details of their injury – If the employee is unable to give a clear and concise description of how the injury occurred, it’s likely that they are not being truthful.
- Regularly out of work due to “injuries” – When something happens more often than it should, it’s usually a sign that something is wrong.
- The story about their injury doesn’t add up – If the story changes or doesn’t make sense, the employee may be lying about how the injury occurred.
- An employee who is seen working or doing physical activities – Social media investigations are a great way to monitor an employee’s activities. If we see that the employee is working or doing physical activities that they are not supposed to be doing, it’s a strong indication of fraud.
You may not always be able to tell if an employee is committing fraud. Some employees are very good at hiding it. But if you do presume that something isn’t right, it’s always best to err on the side of caution and have a professional investigate.
How Workers Compensation Investigations Can Help
If you suspect that your business is a victim of workers’ compensation fraud, the best thing to do is to hire a private investigator skilled at conducting workers’ compensation investigations.
Conducting Surveillance for Workers Compensation Fraud
One of the best ways to catch workers’ compensation fraud is through surveillance. Our investigators will conduct covert surveillance on the subject to see if they are engaging in activities that they should not be able to do based on their injury. This could include working, going to the gym, or running errands.
We use state-of-the-art surveillance equipment to capture every detail and document these activities, so we can provide you with the evidence you need.
Our investigators know how to remain undetected while gathering valuable information, so you can rest assured that they are not letting anyone know what they are doing.
Documentation and Evidence
In order to prove workers’ compensation fraud, we need to collect as much documentation and evidence as possible. This may include videos or photographs of the subject engaging in work or other activities, witness statements, medical records, and more.
We will work with you to compile all of the relevant evidence to build a strong case that can be used in court, if necessary. We know how important it is for our clients to succeed, and we will do everything possible to ensure that any fraud is caught quickly.
Our team of skilled private investigators at Forefront Investigations are well-versed in all aspects of workers’ compensation fraud. They have the experience and investigative skills needed to get you the answers you need.
We understand the importance of discretion and will handle your case with the utmost confidentiality. If you suspect workers’ compensation fraud, don’t hesitate to give us a call. We’re here to help.