Workers compensation cases are not always cut and dry, especially when there is a chance the employee could be committing fraud. While you want to help employees who have injured themselves on the jobs, there are times when the claim is fraudulent.
Workers Compensation Cases
Employees may report an injury that never occurred to receive the payout and some time off work. Sometimes, employees are injured away from the job and attempt to use workers’ comp benefits to pay for their medical expenses. Because deceptive practices can cost your company thousands, investigating the legitimacy of a claim is essential.
Investigative Practices
Companies take several different investigative tactics when looking into a worker’s comp claim. The goal of these practices is to substantiate an individual’s claims. Also, it is to prove the extent of the injury and physical challenges it has created.
Surveillance Equipment
Many businesses employ surveillance cameras to protect their property. Additionally, these devices could capture the comings and goings of employees. The cameras posted around a physician’s office may be necessary to the investigation. It is important because it could reveal an individual who enters the building with assistance but exits without any physical challenges. The same could happen when an individual attends their claim hearing.
Technology can provide time, and date-stamped evidence, both with still or motion captures, concerning a worker’s physical abilities. It can help document the injury by demonstrating the impact it has had on the individual. However, investigative processes will also rely on non-video surveillance.
Private Surveillance
Insurance companies can investigate workers claiming injuries with surveillance to monitor if their injuries are legitimate. These are the techniques one would expect from a private investigator. These individuals know to be discreet and unnoticeable, with the sole purpose of looking for incidents where the injured individual behaves in a way that discredits their injury claim. In addition to making phone calls to check on the individual, these investigators may talk to the neighbors, friends, or family who could speak to the individual’s abilities and activities.
Illegal Surveillance Practices
There are limits to what the insurance companies are allowed to do when investigating a worker’s comp claim. Any activities must comply with the law, making it illegal for an investigator to entrap the individual who made a claim. It means the investigator can’t go undercover and try to photograph or record the individual under pretenses. The investigator is not allowed to trespass on personal property, nor can they use a fake name or identification to elicit information. Additionally, they cannot film a resident inside the privacy of their own home.
Personal Practices
An individual may hurt their worker’s comp case through social media postings. An investigator can look at the activity and photos and use them to support a recommendation for denying a claim.
There are several ways an insurance company will uncover the credibility of an insurance claim. These investigative practices can help your business avoid fraudulent claims and payouts.
About InsureMyWorkComp
InsureMyWorkComp is a digital brokerage that helps clients find the right workers’ compensation solution for their business needs. Unlike other online platforms, we will help you to work with an agent who can provide you the right solution for your risk profile. Our staff has over 50 years of workers’ compensation underwriting and sales experience, and we are confident that we will provide you the support that you need. For more information or to get a quote, contact us today at (855) 340-9138.