Workers’ Compensation Investigations: 10 Signs of Workers’ Compensation Fraud
How a private investigator can assist with workers’ compensation investigations.
With the average cost of a worker’s compensation claim coming in at $41,003, it’s smart for businesses to conduct workers’ compensation investigations. The goal of these investigations is to detect insurance fraud that can cost businesses, insurance companies, and consumers billions.
Why Workers’ Compensation Investigations are Useful
To combat the likelihood of workers’ comp fraud, businesses can work with a private detective to investigate the validity of a claim. A private investigator will conduct interviews and surveillance to determine if an individual is really injured. They’ll also look for indications that a work-related injury is being faked or exaggerated.
Here are some of the most common signs of workers’ comp. insurance fraud:
The Employee Refuses Treatment
An employee who refuses treatment for their workplace injury is instantly viewed as suspicious by a private investigator. A truly injured employee will want to get better. Injured workers who are hiding something are likely to be leery of seeking qualified medical attention.
The Employee’s Story Keeps Changing
If the employee’s story about their work-related injury constantly changes or if the details are inconsistent, this indicates that something is amiss. Thorough workers’ compensation investigations will investigate any variabilities related to workers’ comp claims.
The Employee Has a History of Making Workers’ Compensation Claims
When possible, background checks should be completed before employees are hired. These investigations will confirm that the employee is being truthful about their experience and qualifications.
Your private detective will also investigate whether the individual has a history of making workers’ compensation claims. An individual with a history of workers’ compensation claims should be viewed as suspicious.
The Employee Has a Pre-Existing Condition Similar to the Injury
Workers’ compensation investigations will determine if the employee has previous personal injuries similar to their current injury. Previous injuries mean a doctor will find something wrong during an examination.
The Employee Suffers the Injury After Their Employment Status Changes
An employee concerned about an upcoming decrease in their income may turn to workers’ compensation insurance to cover the shortfall.
The Injury Occurs Before the Employee Needs Time Off
Alternatively, an employee who wants time off for a vacation or personal reasons may use workers’ compensation benefits to get a few weeks off while retaining their job.
The Employee is Struggling Financially
An insurance fraud investigator will examine an employee’s finances to see if their financial situation may cause them to be desperate for money.
The Employee Doesn’t Immediately Report the Injury
Injuries that aren’t reported till days or weeks later call for a workers’ compensation investigation. This gives the employee time to falsify their story and injuries and plan to commit workers’ compensation fraud.
The Employee Remains Active
While an employee is waiting to return to work, their level of activity should be consistent with their injuries. For example, an employee with a back injury shouldn’t be making weekly trips to the golf course or moonlighting at a part-time job. High activity levels are commonly associated with fraudulent workers’ compensation claims.
The Employee is Hard to Contact
Workers’ comp investigations should investigate employees who won’t return calls or can’t be contacted while they’re out of work. This behavior isn’t consistent with an injured individual who wants to return to work.
Contact Sig 14 Investigations for Workers’ Compensation Investigations in Tampa Bay
Want more info on workers’ compensation investigations? Contact Sig. 14, Inc. today! Our private investigator has years of experience conducting insurance and workers’ compensation investigations in Tampa, Florida. Contact us today for more information and to schedule a free consultation with our Tampa Private Detective.