Statistics compiled by the National Insurance Crime Bureau (NICB) state that workers’ compensation fraud costs insurers approximately $7.2 billion a year, causing premiums to increase, forcing businesses to lose money, and making it more difficult for those who are genuinely entitled to file claims.
False workers’ compensation claims is considered to be the fastest growing type of insurance fraud, a crime that Worldwide Intelligence Network has been dedicated to put an end to.
The Worldwide Intelligence Network Advantage
1. As a Workers’ Compensation insurance company, employer, or third party administrator, you will be consistently pleased with the quality, efficiency and professionalism of the investigations Worldwide Intelligence Network conducts on your behalf to resolve claims timely. WIN has successfully acquired witness and claimant statements along with documentary evidence that have established fraud in over 80% of its investigations — yet no investigation is conducted with a preconceived notion that a claimant filed a fraudulent claim.
2. We have performed Workers’ Compensation investigations for a number of national companies and agencies:
- California State Compensation Insurance Fund, performing AOE/COE and Sub Rosa investigations for over 23 years.
- Los Angeles County Risk Management Division, performing AOE/COE and Sub Rosa investigations for 10 years.
- Hughes Air Craft El Segundo, performing AOE/COE and Sub Rosa investigations for 5 years before it was sold to Boeing.
3. We have conducted over a thousand interviews of claimants, supervisors and witnesses, as well as conducted several hundred sub rosa (covert surveillance) investigations. We fairly and lawfully investigate suspected fraudulent claims with high quality video filming and professional report writing.
If you are an uninsured business, you can still combat fraudulent claims.
You forgot to mail in your workers’ compensation premium or you just didn’t have the funds at the time to pay the premium. You had to lay off some employees. Days after the layoffs, one of your employees files a work related injury claim through an attorney. You heard the former employee found another job working under the table and you need evidence to present to the Workers’ Compensation Appeals Board (WCAB). We can help you! You are not alone and you are not the only business that finds themselves in this predicament. We can help gather video evidence that your former employee is working and that the work they are doing contradicts his/her alleged injury.
We gather the evidence you will need to win your case, so you don’t have to pay thousands of dollars in medical expenses and workers’ compensation payments. We can protect you from becoming a victim of fraud.
Insurance Fraud: A Case Study
Insurance companies retain private investigators to conduct surveillance investigations when they suspect a claimant might have filed a fraudulent claim. There are various types of claims for injury such as; automobile accidents slip and falls and Workers’ Compensation claims pertaining to work related injuries. There are basically three types of claims filed for work related injuries. One is an injury/accident that caused the death of an employee, the other is a physical injury and the third is a stress related injury all having occurred while at work. Worldwide Intelligence Network is called upon by businesses and insurance companies to surveil claimants who are seeking compensation for a physical injury allegedly sustained at their place of employment. The objective of this surveillance is to obtain evidence one way or the other that will depict on video whether the claimant is in fact injured as claimed or that the claimant does not appear to be injured as alleged while being videotaped by the investigator. As an example, a claimant reported that he fell down some stairs at work and the claimant went to a doctor who reported that the claimant could not return to work for several months and when the claimant does return to work the doctor wants the claimant to be on restricted work assignments. Restrictions usually amount to the claimant not being allowed to do any physical work at all. There are numerous physicians under investigation for insurance fraud. However, should that same claimant be videotaped lifting and moving furniture into his home when he is supposed to be incapable of any physical activity the video will have a dramatic effect on that claimant’s Workers’ Compensation claim which is all likelihood will be denied and could be referred to the District Attorney’s Workers’ Compensation Fraud Unit.
Another example of fraud was when Worldwide Intelligence Network was assigned a case to surveil a claimant who alleged a severe injury to his foot. He had been off work on an accepted claim for over a year when we were assigned to the case and he was still not back at work. Our client, the insurance examiner suspected fraud due to an independent medical doctor’s report stating he could not find anything wrong with the claimant’s foot. While the claimant was being surveiled and when he exited his home he was videotaped limping. The problem with his limp was that he was limping on the wrong foot. It appeared that this claimant was cautioned by his attorney that he might be placed under surveillance and to be careful when he was out in public. This same claimant was observed going to a Chiropractor’s clinic. Just before he walked into the clinic video was taken of him putting on a foot brace and taking out a pair of crutches from the trunk of his car. When he exited the clinic he took off the brace then he put his crutches in the trunk of his car and drove over to a soccer field where he participated in a soccer game while our investigator videotaped the entire game. However, that was not the end of it because the claimant’s attorney could assert that his client took pain killers that day in order to participate in that game. Surveillance continued and the claimant was caught running from a grocery store during a snow storm while pushing a shopping cart. The claimant ceased receiving payments from the insurance company when a copy of the videotape was shown to his attorney and the attorney resigned from representing the claimant. There are thousands of stories that can be told similar to this one, but unfortunately these fraudulent claims seem to continue endlessly especially due to high unemployment.