Workers Compensation Fraud

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Workers Compensation Fraud No Small Matter for Businesses

What Is Workers Compensation Claimant Fraud? Workers Compensation claimant fraud is the most talked about kind of fraud. It is also the type that employers are in the best position to help uncover. Claimant fraud happens when employees knowingly lie to collect benefits. They may claim an injury was work-related when it wasn't, exaggerate an injury or secretly continue working while collecting benefits.

Here's a good example:

A small business in Seattle suffered four workers’ compensation claims in one year. The claims were so costly that the owner feared for her business. Desperate, she spied on her injured employees outside their business office to see if they were committing workers’ compensation fraud.

Did she over react? Small business owners watching their bottom lines would probably say “no.” Every year, workers’ compensation fraud costs the system millions of dollars. Those costs trickle down to all employers in the form of higher premiums.

Fortunately, employers don’t have to lurk in dark alleys with a camcorder to keep their businesses from becoming victims of workers’ compensation fraud. They can learn to identify fraud and take a proactive approach to fighting it.

What Workers Compensation Fraud Is Not

Collecting benefits for a work-related injury is not fraud. Many employers feel that the longer an employee stays off work and collects benefits, the more likely the claim is fraudulent. Under state law, injured employees don’t have to get back on the job until the doctor releases them to work.

Red Flags for Workers Compensation Fraud

There is no sure-fire way to identify fraud without proof, but there are red flags. Employers should call their carriers immediately if they identify two or more of these flags.

  1. Disgruntled employee. The employee has a motive to fabricate the claim. Perhaps he or she was denied vacation time, demoted or fired.
  2. Employee is hard to contact. The employee may be working another job while collecting benefits. This practice, called “double-dipping,” constitutes fraud.
  3. New employee. Statistically, the newer the employee is, the more likely the claim is fraudulent, especially if other red flags appear.
  4. No witnesses. Make note of alleged accidents with no witnesses, especially if the employee’s duties rarely call for him or her to work alone.
  5. Varying accounts of accident. The injured worker may describe the accident differently to the employer and the doctor, or witnesses’ accounts may differ from the injured worker’s account.
  6. Accidents on Fridays or Mondays. Accidents that occur on Fridays or Mondays should raise suspicion, especially if other red flags appear.

Be proactive

It is easier to prevent workers compensation fraud than it is to prove it. Employers should make sure new hires have the skills and the character they want in their employees. A sound hiring policy is the best place to start.

  1. Hire wisely. Conduct background checks on applicants, and verify references.
  2. Focus on safety. Making the workplace safer reduces the chance of accidents and the opportunity for someone to fake an injury.
  3. Develop a return-to-work policy. Tell job candidates that if they get injured on the job, the company will work with the doctor to help them return to work as soon as medically reasonable.
  4. Educate, don’t threaten. Explain that workers compensation fraud hurts everyone, not just the insurance carrier. Let employees know that fraudulent claims can force employers to decrease benefits, lay off employees, or go out of business.
  5. Adopt a zero-tolerance policy. Make it clear that fraud can carry serious consequences, including termination and prosecution.
  6. Stay in touch. Keep regular contact with employees who are off work due to an injury. Document each contact or attempted contact. Injured workers who are difficult to contact or who are belligerent may be committing workers compensation fraud.

If all else fails, Washington State Investigators is ready to help

If you suspect your employee, employer, or a healthcare provider has committed workers compensation fraud, you need to hire a workers compensation fraud investigator to conduct an investigation.

Reasons for hiring a private investigator to find out fraudulent worker compensation claims

The Private investigator is a trained individual to handle such fraudulent workers compensation claims. He/she has required tools that help uncover the fraud and provide proof that is admissible in the court. The primary step in investigating the worker compensation claim is to detect any possibility of fraud. To uncover fraud in compensation claims it is necessary to act fast before the evidence is destroyed.

What Techniques will Our Investigators Use to Uncover Workers Compensation Fraud?

  1. Interviews and research - Our workers compensation fraud investigators may interview colleagues, friends, family, and other individuals to learn whether there is an issue of fraud and, if so, how great.
  2. Background checks and records research - An investigation into workers compensation fraud may include checking medical records, employment records, and other records. Our private investigators may also run background checks to see whether a worker has filed numerous compensation claims in the past or if the company has a history of mis-classifying employees.
  3. Surveillance - Our investigators may use audio, video, and other types of surveillance to determine whether an individual worker is as injured as they claim.
  4. Evidence gathering - Our workers compensation investigators can gather evidence if they uncover workers compensation insurance fraud. This can help employers and businesses prosecute fraud and cut off workers compensation claims that are not legitimate.

Can Investigators Help Workers Not Receiving Adequate Workers Compensation?

Yes, our investigators can also help workers who are not getting adequate insurance money from workers comp claims. If a business or an insurance company is not paying workers compensation to a genuinely injured worker, our private investigators can gather evidence about the company or insurance company in question. This can help an injured worker get the money they deserve.

Looking for a Workers Compensation Investigator?

Whether you're a business concerned about workers compensation fraud or you're a worker who has not been paid adequate compensation for an injury, Washington State Investigators can help you with your workers compensation fraud investigation.

Washington State Investigators has years of experience with workers compensation cases. We have worked on several worker compensation fraud claims and have the necessary skills and knowledge to save you from spending more of your hard earned money by paying higher premiums due to fraudulent claims. If you suspect that you are a victim of workers compensation fraud, call Washington State Investigators and speak with an investigator today.


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