Workers compensation fraud Archives - All in Investigations

Insurance Fraud Investigations Reveal Blatant Untruths

When it comes to insurance fraud, the bad guys can be quite brazen. Take, for instance, a North Carolina couple who were arrested for insurance fraud and obtaining property by false pretense. It is alleged that Mister filed a claim after an automobile accident with information about lost wages due to the accident. The couple is accused of inflating the amount of wages that were lost and, on top of that, the company he worked for did not even exist. They went to a great deal of trouble to document wages and the company in order to file the claim. Here at we are never surprised or taken aback by the extremes that some people will go to in insurance fraud cases. We have uncovered [...]

Who’s the Fraudster in Insurance Fraud?

Insurance fraud is a huge problem and insurance companies have gotten a reputation for being hard to work with on insurance claims. They see a lot of fraud and the red flags that pop up are taken very seriously. is called in by insurance companies when they see red flags. We don’t make decisions on cases. Our job is to find facts. Sometimes the facts just keep compounding. In one workers compensation fraud investigation, we were asked to surveil a claimant to determine if the patient was really disabled. Workers comp fraud is everywhere and the premiums are very expensive, in part because of the amount of fraud. Workers compensation investigation can include documenting the claimant’s activity as well as their contact with medical providers. [...]

Accusations Proved False with Investigator’s Facts and Evidence

In every professional capacity, staff gathers the truth. But quite often, the general public assumes that the majority of our time is spent finding hidden divorce assets and proving workers compensation fraud. Because of our stellar reputation with lawyers, a defense attorney and his client appeared in our office, desperate for our assistance. The client, Jon (name changed), was a well-known professional athlete who had been arrested and charged with rape. To make the matter even worse, the victim was a minor female, age 17. As you can probably guess, the media was in a frenzy. Jon and his defense attorney requested assistance from our office, to prove Jon’s innocence. Jon admitted that yes, he briefly attended a party where he met and spoke with [...]

Surveillance Equipment Documents Workers Compensation Fraud

Like nearly every other business owner he knew, Lance paid close attention to the bottom line. He felt responsible for employees working in his chain of convenience stores. Many of those employees had been with Lance for more than a decade. In fact, Lance believed his stores were surviving the economic crunch because employees were friendly and fair to customers, just as Lance was friendly and fair to workers. That was exactly why Lance was upset about a workman's compensation claim filed two months ago by a new employee. According to the claim, the employee injured his back and neck when he slipped and fell on a freshly mopped floor. Other employees told Lance the wet area was marked with a cone and no one [...]

Is it Stress or Is It Insurance Fraud?

By the time Hal met with , he looked downright exhausted, not to mention angry. Nothing in life had been easy since the situation at his company had spun out of control. By the way, “the situation” involved Hal's very successful real estate company and Gwen, his very difficult employee. Gwen was hired to be an administrative assistant after Hal explained that the role could be busy and stressful. Gwen had assured her new employer that she could very confidently complete all of the tasks. Hal was so impressed with Gwen that he did not follow through with the routine background investigation. Five months after Gwen's probationary period ended, she began to frequently call in sick. Her absences gradually increased to once or even twice [...]

Is it Pain or is it Workers Compensation Fraud?

When their employee of less than six months claimed that her back was severely injured during a fall at work, Mary and Ted were alarmed. After all, their entire company was built on safety. In more than two decades of being in business, an employee had never been hurt on the job. But soon after the woman claimed to be too injured to return to work, Mary and Ted began to smell a rat. They spoke to other employees about the incident. Unfortunately no one had seen the woman actually fall. There was no video to review since Mary and Ted had never seen cameras as a necessity in their place of business. Shortly thereafter, the employee filed for workman’s compensation. Following that, Mary and [...]

Vehicle Accident Investigation Reveals After-the-Fact Insurance

People buy insurance for all those unexpected happenings in life. But not all people have insurance in place when those events occur. And that can lead to problems – for a lot of people. The Natchez Democrat told the story of a man in Mississippi found himself in that latter group. He did not have insurance and hit a deer. He called a friend who encouraged him to get insurance immediately – and (here’s the rub) then claim the accident occurred after the policy was issued. So, that’s what he did. After getting the policy, the claim was submitted, which prompted a vehicle accident investigation. Sometimes it is not clear when gets called into a case whether it includes auto bodily injuries. But because our [...]

Workers’ Compensation Fraud Investigation Reveals Complex Web

works with workers’ compensation insurance providers investigating workers’ compensation fraud. Through investigative techniques and surveillance, we often can uncover the truth about claimants and their activities. But that’s not all. The company being insured can come under question. Are the employees and wages being accurately reported? Are claims being processed in accordance with the law? A workers’ compensation investigation can also entail investigation into the medical services providers. In fact, sometimes the investigation is centered on the medical services providers. If that is the case, the workers’ comp fraud costs to the insurance carrier usually increases substantially. That is because the fraud can include many patients and many different insurance carriers. One chiropractor in Pennsylvania was charged with filing fraudulent claims to several different insurance [...]

Workers Compensation Fraud Investigation Leads to Surprises

A recent California case reported in the Los Angeles Daily News proves that workers’ compensation fraud is not just about employees and their claims. No, in this case, the employer was revealed to be the perpetrator of workers’ comp fraud. The employer was found guilty of workers’ compensation fraud and sentenced to 29 days in jail, three years of probation and ordered to pay $110,381 in restitution for failing to accurately report employee wages. He was understating wages in order to pay a lower premium for workers’ compensation insurance. He also filed at least one claim during the time in question for an employee’s injury without paying insurance on the employee’s wages. is familiar with the workers’ compensation fraud investigation everyone thinks about – where [...]

What is Insurance Fraud?

What do you think of when you hear the words, insurance fraud? At , we don’t have one description in particular because not only is every case we work on different, but insurance fraud encompasses many different situations. I thought we might take this opportunity to share some of them with you. Workers compensation fraud (WC) – This is over and above a claim for medical expenses. Claimants file claims alleging a disability that prevents them from working as they did previously. It can be a short-term or long-term claim, or even off and on. Workers compensation fraud investigations saves consumers millions of dollars every year. Long term disability fraud (LTD) – This has to do with an insurance policy. Someone buys a policy and [...]