Workers compensation fraud occurs when a claimant, employer, or health care provider knowingly lie to gain an advantage, savings, money, or other benefits. While many people believe that workers compensation fraud solely consists of employees lying about or exaggerating their injuries, workers compensation fraud can involve employers and employees, says Workers Compensation Investigations New York.
If you suspect your employee, employer, or healthcare provider has committed workers compensation fraud, you will need to hire an investigator to conduct an investigation.
Suppose you file a worker’s compensation claim due to a workplace injury. In that case, your employer’s insurance company will expend significant resources to confirm that your injuries are severe enough to prevent you from returning to work at this time. That is why many insurance companies hire private investigators to monitor injured employees to see if the worker is committing fraud, says Workers Compensation Investigations New York.
Not everyone with a workplace injury needs to fear an investigator following them. If the damage is relatively minor and a prompt recovery and return to work is expected, hiring a private investigator is usually not cost-effective for the insurer.
However, workers with a prior history of comp claims, or those filing a large claim, are more likely to have an investigator monitor their recovery. Even if benefits were denied, that does not mean an investigator is not following you to bolster the employer’s case if an appeal is expected.
Techniques Investigators Use for Investigation to Uncover Workers Compensation Fraud
- Surveillance – Investigators may use audio, video, and other types of surveillance to determine whether an individual worker is as injured as they claim.
- Interviews and research – Workers compensation investigators may interview colleagues, friends, family, and other individuals to learn whether there is an issue of fraud and, if so, how great.
- Background checks and records research – An investigation into worker’s compensation fraud may include checking medical records, employment records, and other records. Workers Compensation Investigations New York says private investigators may also run background checks to see whether a worker has filed numerous compensation claims in the past or if the company has a history of misclassifying employees.
- Evidence gathering – Workers compensation investigators can gather evidence if they uncover workers compensation insurance fraud. This can help employers and businesses prosecute fraud and cut off workers compensation claims that are not legitimate.
Investigators can also help workers who are not getting adequate insurance money from workers comp claims. Suppose a business or an insurance company is not paying workers comp to a genuinely injured worker. In that case, Workers Compensation Investigation New York suggests a private investigator can gather evidence about the company or insurance company in question. This can help injured workers get the money they deserve.
Pursuing a workers compensation claim is a complicated, trying experience. Filing a lawsuit is usually done after you’ve been injured seriously and receive medical care or worry about losing income.
Whether you’re a business concerned about workers comp fraud or you’re a worker who has not been paid adequate compensation for an injury, a worker’s compensation investigator can help you.