Why You Need a Third-Party Investigator for Workers’ Compensation Investigations

Why You Need a Third-Party Investigator for Workers’ Compensation Investigations

Workers’ compensation offers invaluable protection to professionals across the USA, but when things get complicated, it can also become a double edged sword for everyone involved. On the one hand, the company that employs the claimant may find reason to believe that their claim is fraudulent in some way. On the other, the insurance company responsible for covering costs following such an incident may feel that the claim is shaky enough to reduce or dismiss the payout. In either case, things can get complicated fast. When these are the kinds of situations you’re navigating, the skills of a corporate investigator—ready to mount a thorough workers’ compensation investigation—will be essential. Their third-party impartial assessment is the only path to ensuring that justice is ultimately done.

Is That Workers’ Compensation Claim Fraudulent?

If you’re a business owner with a sizable claim on your desk and a sense of doubt hanging over you, it can be difficult to know where to turn. Perhaps you’ve got a niggling suspicion that your employee is malingering after extended healing time, or maybe you’re worried that the claim set to push up your premium is based on an injury that was exaggerated or even faked. While workers’ compensation fraud is definitely not the norm, it does happen. In fact, it is estimated that this kind of fraud costs American businesses a shocking $1 billion a year.

The laws that protect your team members’ rights to compensation should not be taken lightly—you can’t just go throwing unproven accusations around without expecting unpleasant legal repercussions. Setting your own HR department the task of looking into the matter might lead to spiraling accusations of bias, but you can hire an appropriately skilled corporate investigations firm to conduct a discreet but effective workers’ compensation investigation on your behalf. 

Yes, a licensed corporate investigator will be able to legally and diligently draw from a toolkit that includes evidence gathering, background checks, online and in-person surveillance, and interviewing witnesses in order to strategically draw the facts together. If all is as it should be, then you can sit back and relax with new-found peace of mind. However, if deception is occurring, you will be able to take action that is robustly backed up by infallible evidence.

When an Insurance Company Questions a Workers’ Compensation Claim

If a claim isn’t legitimate, it makes sense that the insurance company in question isn’t going to be keen to loosen the purse strings. Remember, they are out to make a profit, so there’s no point expecting them to operate purely on the basis of compassion. For a company stuck in the middle of such a quandary, however, this can be a real problem. The absence of the employee who made the claim can leave a big hole in your operational budget, and the process of ironing things out can become a headache that just won’t quit. 

These factors may be motivation enough to hire a third-party expert to carry out a workers’ compensation investigation of your own to back up the claim—particularly if the employee in question is a valued and essential asset. On the other hand, the claimant themselves may be keen to demonstrate the validity of their claim. Being accused of workers’ insurance claim is no walk in the park, and getting ahead of potential legal action brought against you can keep the situation from escalating. Whichever the case may be, the gathering of air-tight evidence by an impartial corporate investigator is the best way to eliminate question marks once and for all.
The task of undertaking a workers’ compensation investigation is a commonplace specialty for the highly experienced corporate investigators from Lauth Investigations International. We turn a deft and seasoned hand to illuminating the facts, leveraging access to the restricted databases used by law enforcement agencies and high-tech surveillance equipment to place truth under the spotlight. If you require assistance in navigating a workers’ compensation claim that has become complicated, we are ready to assist. Contact our team today to learn more.

Worker’s Compensation Fraud | Limping Lawsuit

Worker’s Compensation Fraud | Limping Lawsuit

Case Study | Worker’s Compensation Fraud | Limping Lawsuit

Worker’s Compensation Fraud | Limping Lawsuit

Lauth Investigations was contacted by an insurance respresentative regarding a personal injury lawsuit that had been filed by one of their insured’s employees.

The Subject had alleged that while performing his work duties, he had sustained injuries such as a fractured hip, fractured knee, sternal fractures, broken ribs, and nerve damage in his foot.

The Investigation

Lauth began by conducting surveillance at the Subject’s residence. Subject was observed at the residence letting the dog out.

Subject appeared to walk with a limp and had to use the pillar on his front porch for support several times. An unidentified female would often arrive in a vehicle and drive the Subject around to do errands, as he reportedly could not drive his own vehicle. Subject was observed at one time carrying a rolled up 16×9 rug from the front door of his residence to the rear of his vehicle under one arm, still walking with a limp, but not appearing to struggle under the weight of the rug.

The Solution

After four days of surveillance, Lauth compiled a comprehensive report of their surveillance findings, denoting the Subject’s limp and difficulty with balance.

Lauth provided photographs and video documenting his movements, as well as Subject carrying the run to his vehicle. This report was passed along to the Client for their purposes in processing the claim.

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5 Ways Private Investigators Benefit Human Resources

5 Ways Private Investigators Benefit Human Resources

5 Ways Private Investigators Benefit Human Resources

Our brains are one of the defining parts of our anatomy that makes up who we are as humans, but without vital organs such as the heart, we cannot live to become who we were meant to be. The brain sends signals to the heart to pump vital fluids and maintain the health and fitness of the body in order to grow and develop. In a capitalist world of business and commerce, if a CEO is the brains of a company, certainly Human Resources is the heart. Before any employee can enter a company, they must go through HR, just as vital fluids must pass through the heart before reaching their destination. It is important for Human Resource representatives to be armed with knowledge to allow them to bring in the best and the brightest to contribute to their company. One of the ways HR can rest easy in their hires is by retaining the services of a private investigator to voire dire the candidate base, maintain a healthy work environment, and prevent employee fraud that would damage the company. 

Hiring the Right People 

If proper precautions are not taken, hiring a candidate who might soon be terminated can be very costly to a company. Even if the employee is making minimum wage at the time of their termination, a study from the Society for Human Resource Management estimated it can cost as much as $3500 to replace that employee. The higher the level of employment, the costs exponentially increase, with other estimates claiming that it could cost as much as 150% for middle-level employees and 400% for high-level. Therefore, hiring the correct employee on the first attempt can be critical. As the heart of the company, Human Resources are often overwhelmed with a myriad of tasks, which can make the vetting of potential employees fall lower and lower on the list of priorities. This is where the services of a private investigator will prove prudent. Private investigators can use their time and skills to perform background checks on employees, painting a clearer picture for HR representatives. This helps ensure the hiring of proper employees, which minimizes turnover, and greases the wheels of progress within a company.

Exposing Workplace Theft

A report by CBS News estimated that a typical business will lose 5% of annual revenue to employee theft. Employee Theft Solutions, a division of the Shulman Center for Compulsive Theft and Spending, has estimated that nearly one third of all corporate bankruptcies were the result of unfettered employee theft. Even more alarming, the U.S. Chamber of Commerce estimated that 75% of employed persons will steal from their workplace or employer and will continue to steal if not exposed. It is a staggering statistic that should garner scrutiny from the Human Resources department with regards to their own workforce. Bearing in mind that investigating the behavior of a single prospective employee could be very time consuming, imagine having to vet an entire staff in order to uncover a source of theft. With an average of 3-5 cases at any given time, private investigators have the time and access to resources that can help expose the perpetrator of theft in a company. In addition to checking security systems and interviewing witnesses, private investigators also have the advantage of being able to conduct undercover investigations in order to squeeze out the source of theft. These investigative services can help reinforce the wall that prevents employees from devastating a company with fraud. 

Fraudulent Compensation Claims

A significant portion of the costs incurred annually by employees is attributed to worker’s compensation claims. As a member of Human Resources, it might be easy to trust every single worker compensation claim that comes through the pipeline. After all, yourself or a former superior may have hired the employee, and you trust one another’s respective judgement. However, it is naïve to assume every claim will be legitimate. Worker compensation claims can cost companies hundreds of thousands of dollars per fiscal year depending on the volume of claims. A recent statistic by the Employee Benefit Research Institute in 2014 estimated that it can cost companies as much as a $1.00 per every $100 of employee wages, which can add up very quickly. This is where a private investigator can be a godsend amidst pending litigation. Often in worker compensation claims, interviews are required with the claimant to get their version of events that led up to their injury. While members of Human Resources have many gifts, they may not be skilled in extracting the truth from an employee who might be committing a fraud. Private investigators work to get to the truth every day and can assist the HR department in protecting themselves within the letter of the law. With the resources and due-diligence of a PI vetting the claim, businesses can rest easy knowing that the claims coming through the Human Resources department have merit. 

HR Investigation Integrity 

With the growing problem of drugs in the workplace and the rise of the #MeToo movement, businesses are having more use for private investigators than ever before. A recent article by CNBC details how a rising number of businesses are hiring private investigators in order to identify predators in their workforce before an employee comes forward with claims of sexual harassment, discrimination, or threats. 

“An ounce of prevention is really worth a pound of cure here, because the cost of potential drop in stock price, legal and PR cost — the possibility of regulators getting involved and regulating industries — they are enormous compared with the relatively modest expenditure in hiring folks like us in order to rule out this behavior,” said Nardello, CEO of Nardello & Co.

In addition to identifying these problems to save a business money, it is also imperative that any internal Human Resources department conducts a thorough, prompt, and lawful investigation. Just as private investigators can use their skills to identify predators, they can also protect any HR personnel from compromising the integrity of an investigation, protecting them from legal liability. 

An Objective Eye 

Human Resources: It’s in the name. Whenever there is a problem between coworkers, a discrepancy in payroll, or simple maintenance of a healthy work environment, the human resources department is where employees will turn to address issues in their job. And while members of HR do their best to solve these problems from an administrating and mediating position, they cannot always be objective. After all, HR is just as much a part of the workforce as any other employee, and all of the same implications of camaraderie and friendship can apply. By the same token, HR can also have negative relationships with the subjects of their investigations, which can influence their judgement. These biases can have a toxic effect on office morale, and employees might not feel as though they can trust Human Resources to be fair and impartial when addressing workplace issues. When there is no trust, the important relationship between HR and other departments breaks down. As is the case with many investigative scenarios, a private investigator is always the perfect second set of eyes to have when examining these issues. Without a stake in the outcome of any internal investigation, private investigators can remain unbiased as they conduct interviews, collect evidence, and reach a conclusion in regards to the veracity of any claim. 

It is important for any Human Resources department to safeguard themselves against the many challenges—both internal and external—they encounter on a daily basis in their company. Retaining the services of a private investigator can go a long way to taking pressure off an already busy department, as well as providing an objective third-party perspective that will positively benefit companies as they grow and develop. If CEOs are the brains of a company and the Human Resources department is the heart, certainly a private investigator would be the immune system; identifying problems and staving off possible infection in order to maintain the health and productivity of any work environment.