Keys to a Successful Workers Comp Investigation

A person with a leg in a cast standing on a beach with crutches.

Every corporation has a number of internal components that need extra scrutiny, and workers’ compensation fraud is one of these important components. Even as the economy seems to be on the rebound, this form of fraud continues to rise, which puts a strain on everyone involved.

Why Workers’ Compensation Fraud?

Many see this as a quick option to getting money, without thinking of the impact it will have on businesses and the ramifications of their actions. Businesses, insurers, employees, shareholders, consumers and policyholders are all at high risk, with 10% or more of property/casualty insurance claims being fraudulent, according to the National Insurance Crime Bureau (NICB). It has also been estimated that non-health insurance-related fraud costs the average U.S. family between $400 and $700 per year in increased premiums.

How Can this be Alleviated?

Taking an aggressive stance in protecting the rights of the organization sends a clear message that instances of fraud will be handled accordingly, and limits the high cost that fraud has on everyone involved. Conducting a successful workers’ comp investigation is key. Utilizing experienced fraud experts can help you get to the bottom of your investigation in a discreet and thorough manner. Here are some steps on how this can be accomplished:

A Full Evaluation

When investigating workers’ compensation fraud, carefully evaluating not only the facts of the case, but also the behavior of the claimant is key. There will be red flags that will indicate further investigation is warranted, such as financial problems, the threat of a lawsuit, or a push for a quick settlement.

A Thorough Investigation

If the claimant has grounds for a case, employing the services of professionally trained SIU investigations team that understands the intricacies and confidentiality of workers’ compensation is essential. Our team conducts an in-depth investigation that can include surveillance, interviews, retrieval of records, or a number of other methods used to construct a strong case.

Discovery and Post-Filing

It is important that a solid partnership be in place with a Special Investigative Unit (SIU) to ensure that the plan goes forward and is effective. This ongoing partnership with all parties in the process, from the claims professional to the attorney, is essential in pursuing fraud.

Experts Make the Difference

The services of an experienced and effective fraud consulting firm can make the difference in the outcome of your workers’ compensation cases. With this trend on the rise, putting protocols in place before the situation becomes problematic will save time and money in protecting your best interests.

For a comprehensive consultation on your workers’ compensation cases, contact the Brumell Group today. We are a highly qualified, licensed, and experienced investigative team offering full service fraud consulting, SIU compliance and investigations. For more information on how we can assist, contact our team today.