Private Investigators Clearwater FL
Private Investigators can Reduce Insurance Fraud Costs
By: Gwendolyn Ericks
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The field of Private Investigations is expansive and can include any number of areas ranging from domestic matters to insurance fraud to white collar crimes to just about any other facet of life you can think of. More often than not, the general public tends to perceive private investigators as the person to call when a spouse is suspected to be engaged in an extramarital affair. However, while private detectives do conduct spousal infidelity investigations frequently, this is only a small fragment of the casework a typical private investigator is involved with.
As licensed private investigators with several years of experience, I have handled many cases of various nature. Numerous cases have been in the area of insurance fraud, specifically, disability fraud or workman’s compensation fraud. To be sure, insurance companies and private investigators possess a unique, enduring relationship as there is no shortage of these types of fraud cases. However, self-insured businesses should develop the same relationship with the private investigations industry as the costs associated with fraud can be astronomical. Additionally, history has proven there is much to be gained when self-insured businesses commit the time, consideration, and resources to these types of cases.
Unfortunately, these cases are on the rise and there is no want for creativity as people continually invent new ways to “fraud” the system. As a result, these cases cost employers and insurance companies millions of dollars each year in fraudulent claims with an end result that hurts all of us – insurance premiums that continue to escalate. Employers don’t just suffer financially, but also with a loss of workforce each time someone cannot work due to injury on the job. Now don’t get me wrong, many people that have filed a workman’s compensation claim or a disability claim are actually injured and are in need of benefits. However, there are an alarming number of those out there that continue to “game the system” in various ways.
Several years ago, I conducted a surveillance effort for a large company regarding an employee that worked many years until an “injury” was claimed. The Claimant accidentally slammed his hand in the trunk of a vehicle at work, breaking several fingers, and was out of work for over three months due to this on-the-job injury. After three months of “recuperating”, the Claimant received a doctor’s stamp of approval to return to work. The Claimant however, informed the employer that he was not well enough to return to work and sought additional time off to recover with workers compensation benefits.
A review of the Claimant’s file however, raised the question of whether the Claimant was exacerbating pain levels and injury, or not. Previous x-rays of the Claimant’s injury showed that it had healed properly and that the medical doctor’s belief was that the Claimant could return to work on a “light duty” status.
After an extended four weeks off, the Claimant still claimed that he was unable to work. Meanwhile, the employer received notification that the Claimant was seen delivering pizzas in the small town where he lived. This information was enough to warrant surveillance, which ultimately revealed that the Claimant was, in fact, working at a pizza restaurant. Surveillance video documentation was obtained which evidenced the Claimant loading his vehicle, using both hands to perform work duties. These crucial findings were provided to the insurance company for review, which resulted in the Claimant’s workers compensation benefits being terminated. Additionally, he was required to repay two months of compensation benefits payments that he fraudulently obtained.
Unfortunately, these cases happen every day. Whether a Claimant simply doesn’t want to return to work, or whether a Claimant enjoys two incomes, this type of fraud affects all of us. While it can certainly be difficult to “make ends meet” in today’s society, we know there are better ways of paying the bills than to commit fraud. Insurance premiums are high enough. Unless employers are aware and proactive about these situations, it will only get worse.
And, on a closing note, if you’re a self-insured business worried about the bottom line- remember, insurance companies are VIGILANT about fraud. There’s no question as to the value of their investment in private investigator services. Ultimately, the cost of a private investigation pales in comparison to the potential thousands of dollars that could be paid toward a fraudulent claim. Proactive measures will save your business money and help to combat the increasing prevalence of insurance fraud.
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