Workers Compensation Insurance Fraud Investigations

Workers Compensation Insurance Fraud Investigations

Workers Compensation Insurance Fraud Investigations

Combating Claimant Fraud

Workers Compensation Insurance Fraud Investigations, Insurance Fraud, Work Comp Fraud Investigations, Private Investigations, Insurance Fraud Investigator, Social Media Investigations

Overexertion and falls account for more than $25 billion in workers compensation costs in the United States.  This is indeed a staggering number.  Perhaps more staggering is the fact that fraudulent workers compensation claims account for approximately $500 million in costs just for overexertion and falls alone.

Workers compensation claimant fraud can be broken down into three main types of fraud cases.  First is the outright false claim.  The accident or injury never occurred, or the worker claims a legitimate injury that occurred outside of the workplace as an on-the-job injury.  The classic example of this would be the slip and fall that nobody witnessed, or the employee who hurt their knee playing softball over the weekend but claimed they sustained the injury on the job.

Workers compensation fraud can be broken down into three main types of fraud cases.

The second type of fraudulent workers compensation claim would include the claimant working while collecting benefits.  This is very common in the construction industry, and even public safety.  The claimant may or may not have sustained a legitimate injury, and as result is collecting benefits while being unable to work.  However, the claimant is working “under the table” building decks for his neighbor, or working their part time security job.

The third type of workers compensation fraudulent claim would be the overstated or exaggerated claim.  This type of insurance fraud occurs when he injury is legitimate, however the claimant complains of symptoms more severe than in actuality in order to receive more benefits for a longer period of time.

Fortunately, there are tried and true methods of combating claimant fraud.  According to Brad Balentine, SIU director at David Morse & Associates, conducting surveillance in suspicious claims is an invaluable tool.  Conducting surveillance of a suspicious claim is an “old school” solution that often provides the evidence necessary to present a solid defense against a fraudulent claim.  Here is the rub; surveillance can be expensive.  There is no guarantee of results and often times the investigator will spend hours during periods of inactivity.  If we allow ourselves to be honest, investigators simply cannot predict or dictate the actions of another human.  We can make educated guesses based on the information known at the time, but there is no crystal ball.

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That being said, as investigators I believe we have the next best thing to combat workers compensation claimant fraudSocial media investigations is a force multiplier to traditional surveillance.  According to Brandwatch, 72% of all internet users are active on social media.  This indicates that there is a strong possibility that the subject of a fraudulent claim has some digital footprint on social mediaSocial media investigations leverage the open source intelligence of social media posts to provide actionable intelligence to build a defense against suspected fraudulent claims.

Public information obtained from social media can be compiled and analyzed against specific criteria to obtain a photograph, video, or global positioning coordinate (or combinations thereof) that may provide incriminating evidence against the fraudulent claim.

Social media investigations and the intelligence they provide can assist in the defense of suspected fraudulent workers compensation claims by providing proactive, actionable intelligence, possibly reducing surveillance hours, and increasing the likelihood of success in obtaining evidence through traditional surveillance.  In short, your arsenal to combat claimant fraud must include surveillance and social media investigations.

Chris Kaszak Private Investigator

ABOUT THE AUTHOR: Christopher Kaszak is a partner at Brown, Kaszak, & Associates, a licensed private investigations firm in Maryland.  He is a 22-year industry veteran and has conducted numerous criminal and civil investigations during his tenure in law enforcement and in the private sector, and has conducted numerous workers compensation fraud investigations in Maryland and surrounding states.  Brown, Kaszak, & Associates has been featured on Dateline and TrueCrime for investigative work that brought resolution to a cold case homicide where insurance fraud was the motive.

Workers Compensation Insurance Fraud Investigations, Insurance Fraud, Work Comp Fraud Investigations, Private Investigations, Insurance Fraud Investigator, Social Media Investigations

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