WORKERS COMPENSATION FRAUD/SURVEILLANCE

The workers compensation claims are on a rise and workers file claims for nonexistent injuries, falsify documents of injuries, and many times work under the table while collecting a check from a full time employer. A high percentage of Americans think it is okay to submit a false claim. Many physicians admit that patients have asked them to deceive third party payers to help the patient obtain coverage for medical services. New estimates show fraudulent workers compensation claims account for nearly 25% of the total money spent on workers compensation. As with all types of insurance fraud cases, workers compensation fraud is often characterized by an injury or an incident that is entirely fictitious. With the false claims we all pay from Higher Premiums from businesses, Higher Prices for consumers to pay for goods and services, along with Lost Jobs due to businesses reduce their work force and Loss of Pay from freezes on pay to offset higher premiums.

Some Red Flags Of Worker Compensation Fraud Are:
  • Injured worker is disgruntled, soon to retire or facing a layoff.
  • Injured worker is involved in seasonal work that is about to end.
  • Injured worker took unexplained or excessive time off prior to injury.
  • Injured worker is new on the job.
  • Injured worker is experiencing financial difficulties.
  • Calls to Injured worker are never answered or answered by spouse/relative.
  • Calls to Injured worker have strange or unexpected background noise that may not be at a residence.
  • Injured worker cancels or changes medical appointments.

 

One major obstacle to prosecuting workers compensation fraud cases is the lack of evidence to show intent to defraud. Surveillance on the Injured worker can help obtain the evidence needed for these cases. If you suspect a false claim by one of the Red Flags, “Gut Feeling” or other a surveillance can either prove your suspicions correct or give you peace of mind.

Why Do Surveillance On An Injured Worker?
  • To observe the Injured workers daily routine.
  • To observe if the injury of the Injured worker are accurate with claims.
  • To obtain video/photos of all activity of the Injured worker.
  • To determine if the Injured worker is living within financial means of salary.
  • To obtain the evidence needed to show fraud.
  • Peace of Mind
And When?
  • Medical appointments
  • Early mornings
  • Weekends
  • Friday and Saturday nights
  • Birthdays
  • Anniversaries
  • Holidays
Did You Know
  • 36 percent of all Americans think it’s okay to pad an insurance claim to make up for past premiums. This figure jumps to 42 percent in the urban areas. (Source: Insurance Research Council)
  • More than one in three physicians admits that patients have asked them to deceive third party payers to help the patient obtain coverage for medical services in the last year. (Source: Journal of American Medical Association)
  • New estimates show that fraudulent or exaggerated workers compensation claims account for nearly 25 percent of the total money spent on workers compensation. (Source: Summit Holdings)
Percentage of Americans think it's OK to pad insurance claims
36%
Percentage of Americans in Urban Areas who think it's okay to pad insurnace claims
42%
Of all Workers Compensation Claims are FRAUDULENT
25%
The Price We All Pay
Higher Premiums
Businesses pay higher workers comp premiums because insurers pass the high cost of fraud on to their policy holders.
Higher Prices
Consumers pay higher prices for goods and services when businesses pass the higher premium cost on to consumers.
Lost Jobs
Workers lose jobs because businesses often reduce their workforce, move to another state or even go bankrupt because of higher premiums.
Lost Pay
Business owners freeze or reduce worker pay as they try to offset the higher premiums.
Endangered Worker
Worker can find their health, safety and life savings threatened. They could have a serious work injury but no coverage because their employer illegally avoids buying insurance.

These are just a few examples, Contact Eagle Eye Investigations Group for all of your investigative needs.

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