Investigations for Workers' Compensation Cases

Did you know that approximately 30% of all workers’ compensation claims in the United States are fraudulent? According to the Coalition Against Insurance Fraud, this amounts to an estimated $80 billion worth of fraudulent claims made annually in the United States! If you own and operate a business, either large or small, these statistics should alarm you. Worker’s compensation fraud can damage your reputation with insurance companies, force your premiums higher, and ultimately make your company less profitable, underscoring the need for proper worker’s comp and insurance investigations.

Workers’ Comp Fraud – A Delicate Situation

Investigating fraud in worker’s compensation cases is a delicate situation for any business owner. If suspicion of fraud is raised, it is the employer’s duty to investigate the claim for the sake of the company’s fiscal health. However, a business owner must be careful not to perform such investigations at the expense of their employees’ trust. Ultimately an employer has the obligation to care for an employee who has been injured on the job, and if an employer isn’t careful with their investigation tactics, it can send a message to the workforce that their employer is attempting to wiggle out of such obligations. There is a delicate line drawn between a responsible employer who performs their due diligence, and a paranoid boss who deploys “spies” to constantly watch over their workforce.

Our team of private investigators at Sterling Investigations knows this better than most. For over 25 years, our investigators have been performing Worker’s Comp and Insurance Investigations for a diverse range of companies. We also deal directly with insurance agencies and the attorneys that represent them. We provide a highly professional, specialized service that is designed to handle the delicate nature of worker’s compensation cases. Before an investigation even begins, our private investigators will first advise you on the appropriate laws and statutes pertaining to your case. If and when you decide to hire us for a full investigation, we will utilize state of the art equipment and techniques to make a timely determination as to whether or not your employee is making a fraudulent claim. When we perform a worker’s compensation investigation for our client, we keep these four goals in mind:

1. Determine if the employee is making a fraudulent claim
2. If the employee is indeed making a fraudulent claim, provide clear evidence of such
3. Perform the investigation in the most timely and efficient manner possible – save the client from unnecessary costs
4. Perform the investigation in the most discreet manner possible – do not give the employee the slightest inclination that he or she is the subject of an investigation

What are my Investigative Options?

If you are suspicious that one of your employees is making a fraudulent workers’ compensation claim, there are several types of worker’s comp and insurance investigations available to you:

1. Activity Check – An activity check can be viewed as the preliminary stage of investigations for worker’s compensation cases. It is a short surveillance, usually 1 to 2 days in duration, and is used to determine whether or not an injured employee displays any type of suspicious behavior.
2. Extended Surveillance – If an injured employee indeed displays suspicious behavior during the activity check, then extended surveillance is the next step in the investigation. The purpose of an extended surveillance is to determine and document whether the suspicious behavior seen in the activity check was a one-time act, or part of a larger pattern of behavior.
3. Hidden Camera Surveillance – Often deployed in tandem with traditional surveillance, a hidden camera can be useful in catching an employee performing suspicious activities outside of a specific location, such as their home.
4. AOE/COE – An AOE/COE (Arising Out of Employment / Course of Employment) investigation is the non-surveillance aspect of a workers’ compensation investigation. Its use is to verify the purported facts surrounding a worker’s compensation claim. It includes a background check on the employee, such as conducting interviews and obtaining statements from witnesses.

If you suspect an employee of Worker’s Compensation Fraud, call Sterling Investigations today at 1-800-873-5509, or e-mail us at info@ajsterling.com for a consultation on worker’s compensation cases.