Workers’ compensation (comp) payments can be a lifeline for employees who get injured on the job. It can help give them financial peace of mind until they are ready to return to work. Ultimately, these benefits can amount to several thousands of dollars. Unsurprisingly, some dishonest individuals will try to take advantage of the system by faking injuries to claim payouts. Workers’ comp fraud has skyrocketed over the years, prompting employers and insurance companies to regularly conduct workers’ comp investigations, especially on suspicious claims. CaptureINTEL is here to help.
Conducting a Workers’ Comp Investigation
The most common examples of workers’ comp fraud include faking an injury or illness, working while collecting benefits, exaggerating injuries to collect more money or prolong payments, claiming a non-work-related injury as work-related, and requesting reimbursement for a medical treatment that was not received. CaptureINTEL’s trained field agents use three common methods during a workers’ comp investigation to obtain evidence to prove fraud.
Our professional field investigators have decades of experience catching individuals faking or exaggerating their injuries. They are trained to remain discreet and follow proper surveillance procedures. The subject in question is kept under discreet plain-view observation. This type of surveillance requires a unique set of skills and can be labor-intensive, as the subject will need to be monitored until the truth is uncovered. One crucial goal in any field investigation for our company is to avoid alerting the subject to the presence of surveillance. This is becoming increasingly difficult as the attorneys representing the claimant pass on past information and coach the claimants to beware of their surroundings.
Our investigators can monitor the subject’s activities on social media channels and other online platforms. They can check for status updates, pictures, and other virtual content from the subject and their friends/family. CaptureINTEL Director of Field Operations, Investigations, Brad Wittrock, noted, “In 2023, social media has become a great resource for employers, insurance companies, and investigators. Social media is typically the best starting point for all investigations. These online forums are beneficial in numerous ways; Finding current photos of the subject/claimant; Identifying the capabilities of these individuals; Identifying their hobbies and interests; Identifying family members, etc. We do not just stop at the subject/claimant. We also look into the accounts of their friends and families as well. Sometimes the individual might not post current or updated photos, but family and friends might.”
Our investigators may also interview the subject in person or over the phone to gather intel. Although the subject is not legally required to participate in the interview, it increases suspicion of fraud if they deny it. Friends and family members are a great source of information regarding the subject’s injury. If deemed necessary and approved by the client, our field agents may interview the subject’s relatives, close friends, neighbors, and co-workers to identify inconsistencies or potential proof of fraud.
A Workers’ Comp Investigation Case Study
A roofing client hired CaptureINTEL through its insurance agency to conduct surveillance on a subject who was allegedly injured and collecting workers’ compensation. The client knew that the subject’s brother owned his own roofing company and suspected that the subject was being paid cash for extra work on top of his workers’ compensation payment. While surveilling a house for a different case, a roofing van pulled up to the house across the street with four occupants. As they exited the vehicle, we immediately recognized one of the individuals as the subject we were actively monitoring for this insurance fraud case. He proceeded to tear off shingles, clean up, and carry bundles up a ladder for the next eight hours, confirming that he was not injured and was “double dipping” his benefit payment and the extra cash from his brother. It ended up being a 2-for-1 kind of day.
At the end of the day, workers’ comp fraud can be considered a felony and is punishable by law. CaptureINTEL is here to provide comprehensive assistance with a workers’ comp investigation for any suspicious claims in Minnesota, Wisconsin, South Dakota, and Arizona. Connect with our team today, and we will be happy to act as your eyes and ears on the ground!