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Workers’ Compensation Fraud Investigations

Worker Compensation Claim

Once there are accident case involved at workplace, there are many party will be involved in the case other than Ministry of Manpower (MOM). Basically, the Employers (Occupier), claims adjusters and self-insurer will use our investigation services to assist in identifying the proving fraudulent claims or civil lawsuits. We will provide detail reports for the case and surveillance results. Our Investigators are trained in person surveillance, activity checks and various type of accident fraud claims.

Why involve of Private Investigator?

Basically, the workers compensation insurance are means to protects the employee that are hurt on the jobs and covered the medical expenses, lost wages and other expenses and compensation result from the accident. However, there are small numbers of scam is using the case for personal profit and fraud the claim.

The false claims are a criminal case and it will result of increase of premiums in future which is draining the business profit.

With in-depth investigation, it can minimise the fraud claims and send a clear signals to the workers and prevent reoccurrence of the cases.

 

Fraud claim

Types of Fraud Case

 Bogus claims

There are cases of dishonest employees falsely claiming the injury on the current job but in the real case is on the other job site.

They are dishonest worker collect the insurance money and compensation and claimed that they’re disable while pursuing their hobbies ( sports etc.) & other activities or work on the other workplace.

Common example:

  • Worker gets hurt off the workplace but say they’re hurt at work. Like sprains the ankle, back.
  • Inflated the injuries to collect more compensation and stay off the job longer.
  • Fake injuries such as muscle problems at their back and neck where hard to disprove.
  • Existing injury or old injury. The occurrence of damage knee or shoulder in previous incident.
  • The worker can stay at home longer by pretending is still disable even though it is healed and fit to work.

 Dishonest doctors & lawyers

There are cases involved of dishonest clinics and lawyers when team up to scam the insurance.

 Common examples:

  • Inflated injuries.

    • Clinics may inflate the seriousness of real injuries to workers, then bill insurers for costly and worthless treatments and tests.
  • Phantom injuries.

    • Clinics may bill insurance for treatment of injuries that never happened.
  • Bogus lawsuits.

    • Shady lawyers working with the workers and in some case involved clinic to request to settle than face an expensive lawsuit.
  • Illegal kickbacks.

    • Dishonest clinics and lawyers hire runner to bring workers into the scams. The runners receive illegal kickbacks for referring patients to the lawyers or clinics.

 

The set back of Fraud Claims

There are price to pay for such worker compensation fraud and business owner or employer and even the worker:

  • Pay higher premiums.

    • The employer or businesses will face to pay higher premiums of workers compensation premiums when renew.
  • Lost jobs or pay

    • The worker may results in lost jobs due to cut workforce by employer and the business freeze or reduces worker pay due to the increase of business cost.
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