Workers’ compensation is a type of insurance that provides benefits to employees who become ill or are injured while performing duties within the scope of their employment. Unfortunately, an employee may intentionally misrepresent or exaggerate their injuries to obtain benefits they are not entitled to. If you suspect workers’ compensation fraud, it’s in your best interest to contact the skilled Connecticut Private Detectives at Advanced Investigations, who can gather evidence to verify the legitimacy of a claim.
What is Workers’ Compensation Fraud?
Workers’ compensation fraud occurs when a claimant, an employer, or a healthcare professional lies to gain compensation, more funds than their claim is worth, or benefits. There are several reasons why workers’ compensation is an easy crime to commit, prompting many to attempt it. The primary reason people commit workers’ compensation fraud is to receive money they wouldn’t otherwise be eligible for due to a work-related injury or illness.
Examples of Employees Committing Fraud
Some examples of workers’ compensation fraud include, but are not limited to, the following:
- Claiming an injury that was never sustained
- Exaggerating the severity of an injury
- Staging an injury
- Working while on leave and still collecting benefits
- Working a side job while still collecting benefits
- Failure to follow the doctor’s recommended treatment plan to prolong benefits
Employer or Provider Fraud
- Underreporting payrolls
- Intentional misclassification of employees
- Billing fraud
Why Workers’ Comp Fraud Matters for Connecticut Businesses
Though workers’ compensation fraud may seem like something that only impacts the insurer, this is far from the truth. In reality, it can impact a business through:
- Higher insurance premiums
- Loss of productivity
- Cost burden on coworkers
- Delays and customer impacts
This can result in an unhappy workplace for employees who have to take on extra responsibilities, thus translating to a worse customer experience for your clients. Ultimately, this can result in a loss of business.
How Do Private Investigators Detect Workers’ Compensation Fraud?
Private investigators can help collect important information to protect your business. However, you should note that these individuals do not replace insurance adjusters or law enforcement officers. Instead, they provide important, supplemental, legally collected evidence to help support your business. Understanding the methods used by private investigators to collect information and evidence in order to detect fraud is critical.
Surveillance and Evidence
When it comes to workers’ compensation fraud investigations, surveillance plays a critical role. Private investigators will survey the persons of interest, tracking their whereabouts, and document their movements to look for inconsistencies and contradictions that deviate from their medical restrictions.
Social Media Investigations
In many instances, investigators will examine the social media accounts and activity of those who have filed for workers’ compensation. This can be integral in determining the validity of a claim. For example, if an employee claims they cannot work because of a back injury, but their social media account shows them engaging in activities that require a lot of movement, this can be used as evidence to deny the claim.
Interviews and Background Checks
In addition, a private investigator can perform background checks, which can reveal an individual’s history of filing previous workers’ compensation claims, potentially indicating a pattern of fraudulent activity or a propensity to file exaggerated claims. If a worker has a history of pursuing workers’ compensation claims or has such cases against multiple employers, the private detective can use this as evidence that the claim is unjustified.
How Businesses Can Prevent Workers’ Comp Fraud Before It Happens
Fraudulent workers’ compensation claims can be incredibly disruptive for your business while contributing to long-term impacts on your company. As such, understanding the steps you can take to reduce the risk of workers’ compensation fraud before it happens is critical.
Screening and Hiring Practices
Updating your hiring process to include background checks and reviews into the employment history of applicants can help you determine the risk factor of potential employees. While this will not completely eliminate fraud, it can help reduce the risk.
Workplace Surveillance and Documentation
One step many employers have taken to reduce the risk of fraud is installing cameras. This will help confirm how incidents have occurred in the workplace, allowing you to determine whether or not a claim is fraudulent. Additionally, you should hold regular compliance and workplace injury prevention meetings with employees to ensure that everyone is on the same page in terms of safety.
Injury Reporting and Response Plans
You should ensure that managers and supervisors are properly trained in the incident response procedure. This not only ensures that injuries and evidence are promptly documented, but it can also help standardize reporting to reduce inconsistencies and issues with statements.
Contact Our Dedicated Connecticut Private Investigators Today
Without a proper investigation, workers’ compensation fraud could continue going on right under your nose and remain undetected. If you have reason to believe that an employee has committed workers’ compensation fraud, working with an experienced private investigator with Advanced Investigations is critical. Our team understands the impact these matters can have on your business, which is why we are committed to helping you find the answers you need to proceed. Connect with us today to learn more.
