Advanced Investigations

How Do Workers’ Compensation Investigations Work?

workers' compensation claim

If you’re a business owner, from time to time, you may have a worker who has become injured while performing the duties of their position. However, before you take everyone at their word, you should take the necessary steps to determine the validity of their claim. Unfortunately, workers’ compensation fraud is common and poses a serious threat to businesses. Please continue reading to learn how our seasoned Connecticut Workers’ Compensation Claim Investigators can help you ensure your employees are not taking advantage of you. 

What is Workers’ Compensation?

Firstly, workers’ compensation is a type of insurance that most employers must carry for their employees. Essentially, it provides financial and medical benefits to employees who are injured or become ill due to performing activities within the scope of their employment. While it’s intended to protect workers from the financial burden of their injury or illness while they can’t work, some workers try to take advantage of the system by filing false claims.

Workers’ compensation fraud occurs when a claimant, employer, or healthcare professional willfully makes a false statement, conceals information to receive benefits, or prevents someone from receiving benefits to which they might be entitled. For many, workers’ compensation fraud is easy to commit as employees are usually not monitored every second of every day they’re on the job. This makes it possible for employees to fake an injury or illness. The following are some examples of how workers’ compensation fraud can be committed:

  • Claiming a non-work-related injury as a work-related injury
  • Faking or staging an injury
  • Malingering or exaggeration of symptoms
  • Pre-existing injuries
  • Not visiting a medical professional right away or intentionally missing appointments
  • Working while allegedly disabled and not reporting income
  • Claim filed for injuries that have no witnesses

As you can see, there are numerous ways in which employees can commit workers’ compensation fraud without being detected. However, this can be detrimental to a business. To prevent fraud, they should enlist the help of an experienced workers’ compensation investigator who can determine the legitimacy of employee claims.

What Does an Investigation Entail?

If you believe an employee is falsely claiming their injuries or exaggerating them to get more benefits than they are entitled to, you need to take action. A workers’ compensation investigator can help employers uncover fraud to prevent exploitation. Insurance companies and employers hire investigators because they conduct surveillance to establish the veracity of a claim and the extent of an injury or illness to determine the appropriate compensation.

They will review security footage showing whether the injury was caused by a work-related accident or if they’re fabricating their injuries. They will check if the employee had any pre-existing conditions that could have contributed to the workplace injury and even look into whether they were following proper safety protocols at the time of the accident. If they contributed to their work-related injury, putting themselves at risk, then their claim could be denied or reduced.

If you have suspicions of workers’ compensation fraud, please don’t hesitate to contact a skilled private investigator from Advanced Investigations, who can help you uncover whether an employee has filed a false claim.

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