What is Workers’ Comp Fraud and How Can a Private Investigator Help?

What is Workers’ Comp Fraud and How Can a Private Investigator Help?

by | Nov 12, 2015 | Corporate Investigations, Tips & Facts

fraud 2Workers’ compensation is an insurance program that is designed to assist employees who become injured on the job or suffer a job-related illness. Unfortunately, not every claim that is filed is legitimate and the business is often the one that pays the price. In fact, more than 1 in 10 employers are concerned that a worker will fake an illness or injury in order to fraudulently collect workers’ comp benefits. Let’s take a closer look at the different types of workers’ comp fraud and what you can do to protect your company from becoming a victim.

Types of Workers’ Comp Fraud

False Claim – This occurs when an employee is never injured at all, but claims he or she was on the job in order to collect insurance payments. In some cases, a worker may actually go to the extent of injuring him or herself (usually by staging an accident) to bolster their claim.

Working While Collecting – Another costly form of workers’ comp fraud occurs when someone who may or may not be legitimately injured and is subsequently collecting benefits stating he or she is unable to work, but is actually working elsewhere at another job.

Exaggerated Claim – These are cases in which an employee legitimately sustained an injury, but is exaggerating its severity in order to extend the amount of time off and benefits he or she can collect.

Employer Fraud – In some cases, the business itself may be engaging in behavior that is classified as workers’ comp fraud. This is typically done through employee misclassification. In other words, a company will erroneously list a full time worker as a contractor to avoid having to pay higher premiums.

Not sure which, if any, of these types of workers’ comp fraud are occurring? Here are 10 warning signs to watch for.

How a Private Investigator Can Help

If a business suspects that one or more employees are engaging in workers’ comp fraud activities, it can be wise to enlist the help of an experienced private investigator. This professional can then do the following in order to identify areas of legitimate fraud and also build a case against the offender:

Gather evidence. This may include conducting surveillance of the employee in question and capturing evidence of dishonesty. For example, the investigator may take video or pictures of the offender working at another company on the side or engaging in physical activity that is not consistent with the supposed injury or illness.

Conduct background investigation. In many cases, a person who commits workers’ comp fraud has a long history of similar claims. A thorough background investigation can reveal patterns that may raise suspicion and concern and can also help build a stronger case against the offender.

Documentation. Once all of the necessary evidence is collected and a detailed background check has been performed, the final step in the workers’ comp fraud investigation will be compiling all the documentation needed to pursue the case.

Could workers’ comp fraud be costing your business money? Don’t take chances. Trust the experienced team at Lauth Investigations International, Inc. to handle your case swiftly and efficiently. We can help you get the evidence you need to mitigate your damages and avoid becoming a victim again in the future. Call us today to learn more.

What is Workers’ Comp Fraud and How Can a Private Investigator Help?

7 Steps to a Successful Workplace Investigation

by | Nov 10, 2015 | Corporate Investigations, Tips & Facts

Writing ToolsDespite your best efforts, complaints and internal issues will sometimes arise in the workplace. In these instances, a thorough investigation of the situation can vastly improve the chances of a favorable outcome for your company. For instance, the information you uncover can help build a case and/or protect your firm’s hard-earned reputation. If you’re dealing with a potential problem, such as employee theft, fraud or drug abuse, here are 7 steps to conducting a successful workplace investigation.

Identify areas of concern. Everyone in management should understand what the signs of potential problems are so they can notify the appropriate parties and action can be taken. For minor issues for which employees all agree that what occurred isn’t of significant concern, a full-blown workplace investigation may not be necessary. In most cases, however, it’s usually better to err on the side of caution.

Act swiftly. The moment a potential internal problem is identified, it should be addressed. Waiting to conduct a workplace investigation could cause further issues. For example, not properly looking into reports of potential employee drug use or theft could result in everything from a decrease in morale and higher turnover to loss of revenue.

Enlist the help of an experienced investigator. Unless your business employs an individual or team that is specifically dedicated to internal investigations, enlisting the help of a trained, experienced professional to conduct the workplace investigation may be the wisest choice.

Plan the investigation. Having a well-thought-out plan of action in place beforehand can do wonders for ensuring that a workplace investigation goes as smoothly as possible. Obviously you can’t plan for everything, but you should at least have a framework from which to work. If you’ve hired a private investigator, this will likely be part of his or her initial investigation process.

Gather and evaluate evidence. While your goal should always be achieving a resolution without the need to go to court, sometimes litigation is unavoidable. That’s why gathering adequate evidence is so important, whether it’s documentation, photographs or sworn statements. The more legwork you do to bolster your case, the better the outcome will likely be.

Document everything. Each step of a workplace investigation should be well-documented. This, in effect, will cover your business should any questions arise down the road, particularly if the case ends up in front of a judge. A strong case will have all the documentation needed to back it up.

Follow up. The actual follow-up needed after a workplace investigation is conducted will vary based on the situation, but it should always be a part of the overall process. For instance, in the case of employee drug abuse, follow-up should be done to ensure that the situation has been resolved and that other team members are satisfied with the outcome.

Do you need assistance with an internal workplace investigation? Give us a call and let’s discuss how one of our experienced private investigators can help.