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.