Worker’s Compensation Insurance Investigation

workermans-comp-fraud-insurance-form-rejection

An employer’s requirement for workman’s compensation insurance is a protective measure to support fairness for both the company as an organization, and the staff as individuals. In 2012, there were over 3 million non-fatal work accidents, or approximately 3 injuries for every 100 employees. While most claims are valid cases, workman’s comp fraud does occur; It can cause devastating financial loss to your business and reduces benefits to those who legitimately need it. NCIB reports that questionable claims increased by 28% from 2011 to 2012 alone. In the past decade, worker’s compensation fraud has resulted in:

  • Over $4 billion in biased insurance premiums
  • Nearly $25 billion in false disability claims
  • A compounding average cost of $1000 annually for employers to cover these claims

Hiring a private worker’s compensation fraud investigator to investigate your workman’s compensation claims can help to prevent and mitigate these losses. If you are unsure if insurance fraud is occurring in your business, see our previous post on potential signs that an employee is committing workman’s compensation fraud. To summarize, these are a few indicators that a claim may be questionable:

  • Accidents without witnesses – this could indicate an employee attempting to use worker’s compensation to pay for treatment of an off-the-job injury, or to claim an injury where none has happened.
  • Lapse of time in seeking treatment for or reporting the injury – this can raise further warning signals through the use of medical providers who are not on the list of acceptable resources for such injuries.
  • Multiple claims and extended recovery time – this practice could also indicate a possible fraudulent activity and may warrant investigation.

Regardless of the certainty of a claim being valid, you should still hire an anti-fraud investigator to help you verify any claims, even if there is no wrongdoing. By setting a standard of due process and quality control in the claim process, it improves company culture and sets a precedent that honesty and truth are valued by all members of the workplace.

 

Ways Our Private Investigators Can Help Prevent and Mitigate Workman’s Compensation Fraud:

Background Checks

Our comprehensive background check services can provide information on any previous claims or frivolous lawsuits a claimant has made with previous employers. Revealing a claimant’s past history could be an inclination that their claim is fraudulent. Background investigations can also be performed on the medical practice the claimant used to submit the claim. See our employee background check service for more information.

 

Clinical Inspections*

Our professional Long Island private worker’s comp investigators can perform clinical inspections for insurance claims in the Long Island, New York City, and Tri-State areas. We work with both small and corporate businesses in ensuring quality control for the examinations and verify legitimacy of the practice. Our professional investigators can collect records and document the facility, as well as perform surveillance to verify if the practice is overstating the number of patients seen for claims, or if the facility even exists. We also offer record and monitoring services for IMEs (Independent Medical Examinations) of the claimant and doctor for quality assurance. All of the recordings are submitted to the insurance company for review and to maintain their records. *Patients must have signed waivers allowing video recording of the medical visit in order for Radius Investigations to perform this service.

 

Social Media Investigations

We have experts who specialize in gathering intelligence online and on social media. Our social media investigators can gather and provide potential evidence of a claimant’s activity that is contrary to the injuries they claimed.

 

 

 

Activity Checks/Surveillance

If a claimant is suspected of fraud, our nationwide network of private insurance fraud investigators can perform activity checks to confirm the claimant’s injuries. We use the latest technology to leave no stone unturned in gathering evidence: Our investigators can also use surveillance to monitor if and when the claimant enters a medical facility for an appointment or treatment. See our work featured in the NY Post for our use of drone tech for surveillance and activity checks.

 

Don't let another workman's compensation claim go unverified.

Don’t let fraudulent workman’s compensation claims rob you and your fellow employees. Verify claims with our expert insurance investigators from Radius Investigations!

We are Available 24/7 1-888-698-0077