This article provides an overview of worker’s compensation investigations. In 2015, $61.8 billion of benefits were paid to workers who were injured in the workplace. A percentage of those claims were fraudulent and required a worker’s compensation investigation.
What is Worker’s Compensation?
Workers compensation programs are designed to protect employees who are physically injured during the course of their work. Worker’s compensation benefits are paid to a worker to compensate for losses caused by a work-related injury or illness. If someone is injured on the job, they may not be able to work for a period of time, and therefore can’t earn an income.
The worker’s compensation benefit seeks to provide the injured person with an income during the time when they are unable to work, or can only work at a reduced rate or capacity. Workers’ compensation is generally a “no fault” system in which the injured workers receive medical care and financial or monetary compensation benefits regardless of who is responsible for the job-related accident.
Additionally, the program provides death benefits to the survivors of a worker who died as a result of being injured on the job.
Some individual’s file fraudulent worker’s compensation claims in hopes of collecting insurance money, even though no actual injury or loss occurred on the job. Insurance companies, attorneys, and corporations may hire private investigators to help obtain proof of a fraudulent worker’s compensation claim.
Worker’s Compensation Investigations: Investigating Fraudulent Claims
Fraudulent insurance claims cost the industry billions of dollars each year. To reduce the amount of losses that occur due to fraud, insurance companies thoroughly investigate all claims. In some cases, they use in-house investigators. In others, they outsource the job to a local private investigator.
Private investigators may be hired to obtain proof of fraudulent worker’s compensation claims by conducting surveillance on the individual. In this capacity, private investigators may be referred to as worker’s compensation investigators. Types of information collected during surveillance can include video taping and taking photographs of the subject’s actions and behavior.
The goal is usually to catch the person doing something that is inconsistent with their injury. Examples include capturing a picture of someone bowling, when they supposedly sustained a back injury on the job. Or, catching someone running when they supposedly injured their ankle at work.
In addition to catching the person in the act, there are other methods that an investigator might use to determine if someone is filing a fraudulent claim. Interviews with the claimant may reveal that the injury occurred without any witnesses. While this alone doesn’t prove a false claim, it can serve as a piece of the overall puzzle.
In addition, the interview may reveal additional information, such as when and where the accident or injury took place. In some cases, investigators determine that the actual injury took place while the individual was not at work.
Worker’s compensation investigators may run a background check related to the case. A background check may reveal evidence of financial difficulty, or a history of filing insurance claims. As part of the background check, an investigator may speak to previous employers, other insurance companies, and others.
Hire a Private Investigator for Your Case
To locate a private investigator in your area that specializes in providing surveillance services for workers compensation investigation cases, please visit our Private Investigation Directory.
Worker’s Compensation Resources
Workers Compensation – Provides workers compensation news and information for employees, employers, insurers, and medical providers. Includes a workers compensation research center, locate an insurance provider, get info on your state’s program, and find professional help relating to workplace injuries and disabilities in the U.S.
For more information, and to lookup the state website and appointed officials, please visit the United States Department of Labor.
If you are interested in purchasing the latest surveillance equipment to conduct worker’s compensation investigations, please see our Spy & Surveillance Equipment section. A variety of high-tech gear is available to help you watch subject’s behavior and capture photos or video of their action.
Questions and Comments
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