A workers’ compensation fraud investigator can be extremely important for those who believe they are being taken advantage of by a person or organization misrepresenting their insurance. Insurance fraud is a significant issue that costs Americans billions of dollars per year, according to the FBI’s workers’ compensation fraud statistics. Although the definition varies depending on the situation, here are some of the most common reasons that you might hire a fraud investigator.
1. The person making the claim has been seen out & healthy by others
Workers’ compensation claims are supposed to be made by people who have an injury serious enough to stop them from working. However, if you’ve heard that a person who claims to be injured has been seen functioning normally, it could be the right time to hire a workers’ compensation fraud investigator.
2. There wasn’t sufficient medical documentation on the claim
If someone gets hurt badly enough for it to interfere with the work they do, the odds are good that there will be a doctor’s report, medical chart, and other kinds of records available to corroborate the incident. If a workers’ compensation claim doesn’t have enough documentation from healthcare officials behind it, an investigator might be necessary.
3. The victim’s story about their injury is inconsistent
Maybe they reported their injury one way to their colleagues or supervisor, but when it came time to talk to a doctor they changed their story. Inconsistencies in a testimony are a red flag that there might be something illegal going on with the party filing the workers’ compensation claim.
4. Witnesses disprove the testimony of their compensation claim
If the person who was injured was around other people when the incident took place and these witnesses don’t back up the account of the victim, you may want to think about hiring a fraud investigator.
5. A business uses the same doctor in multiple insurance claims
Companies that employ immoral healthcare providers to validate workers’ comp claims will often file multiple reports that involve testimony from the same doctor. If you’ve noticed this pattern in claim reports from a particular source, they may be committing fraud.
6. A claim comes at the end of a large project or right after a work stoppage
Companies and individuals that have inconsistent working schedules may attempt to commit workers’ comp fraud as a way to tide them over between jobs. If claims are commonly filed from the same source when work goes away, it could be a sign of fraud.
7. A company has a suspicious number of employees listed as safe
This sign mostly applies to companies with lots of at-risk employees. For example, a construction company that works with heavy or dangerous materials should have many employees listed as at-risk. If they don’t, there’s a chance that the company is committing fraud against their workers’ compensation insurance provider.
Whether you are a business owner or an insurance provider, don’t become one of the cautionary workers’ compensation fraud stories. Hire a certified fraud investigator to help you get to the bottom of any suspicious workers’ compensation situation.
If you’re concerned about a workers compensation suit and would like to seek professional assistance from a fraud investigation company, contact the team at Veriti Consulting LLC by calling 855-232-4410 or send an email.
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