• Kara Hipps


Updated: Mar 4, 2019

Does the evidence support the claim? If the answer is anything other than a solid yes, consult a private investigator.

Workers’ compensation coverage is a great benefit to have. It pays for lost compensation and medical bills for people who sustain an injury while at work.

According to the Department of Labor, a total of $288,353,761 has been paid out to Georgia claimants for compensation and medical bills due to workers’ compensation claims as of April 2018. Approximately, 1%-2% of claims are fraudulent. Based on a 2% figure, $5,767,075.22 have been paid to criminals.

Fraudulent insurance claims cost you money.

How does this affect everyone else? Anytime money is stolen, it must be replaced. Unfortunately, there is not a money tree growing behind the Workers’ Compensation office, so consumers pay for it in the form of higher premiums. Meanwhile, the criminals sit home collecting a pay check.

How can Fraud be Detected?

The detection process should start with the employer doing the initial investigation. The injured party should be interviewed regarding the details of the incident and then any witnesses should be interviewed. All details should be thoroughly documented.

The workers’ compensation doctors should be thoroughly vetted to make sure there is not a history of collusion or fraud regarding workers’ compensation fraud. The vetting process should not be a one-time deal, it should be done periodically for obvious reasons.

There is only so much an employer can do without putting the company at risk for litigation, so other measures must be taken.

A private investigator can obtain evidence to support a legitimate claim or expose a fraudulent one.

How can a Private Investigator Help with Workers’ Compensation Fraud?

Even if the employer does his or her due diligence to confirm that the employee has filed a legitimate claim, the investigation doesn’t stop there. The employer can follow the employee’s social media sites and talk to other employees who know the claimant. If the employee is in fact committing fraud, these are the two most valuable information sources.

Once the employer has information leaning toward a possible fraudulent claim, a private investigator will be the key to proving the fraud. A private investigator is hired to follow the subject for the purpose of obtaining photographs and video of the subject performing tasks that he or she shouldn’t be able to perform due to his or her injury: hence the reason he or she is out of work.

Not all claims start out as a fraud. The employee can be legitimately injured at first; however, a legitimate claim turns fraudulent after the employee has recovered, but lies about his or her condition to avoid going back to work.

Worker’s compensation benefits are valuable, but if you know someone who is abusing the system, speak up. It may seem like a victim-less crime, but when the money is being stolen from you through higher premiums, that makes YOU the victim.

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Red Flags Associated with Fraudulent Claims:

· The incident was not witnessed.

· There was a delay in reporting the injury.

· The physician’s notes don’t support the claim.

· The employee’s detailed account of the injury either changes, is inconsistent, or is vague.

· The timing of the claim is right before and/or right after a weekend, a strike, a holiday, or a termination.

· The employee has a history of filing worker’s compensation claims.

· There is evidence of the employee performing activities that the employee shouldn’t be able to perform based on the reported injuries and restrictions.

Remember, 98% to 99% of claims are legitimate, but the 1% to 2% that are fraudulent cost you, the consumer, your hard earned money. Click here for more information.

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