Investigation Solutions saves carrier client $150,000 in work comp claim fraud

Working on behalf of their carrier client, our subsidiary Investigation Solutions, Inc. (ISI) filed a work comp fraud case with the District Attorney, obtaining a conviction of a former employee hired as a driver. The driver filed a fraudulent claim after he was terminated. He was found guilty of insurance fraud and ordered to pay more than $84,000 in restitution.

The denied claim involved a driver who worked for the carrier’s insured for five years before being terminated.

Two months after termination, the claimant hired an attorney and alleged cumulative trauma injury to ear, wrist, hand, shoulder, knee, stress and nervous system during almost the entire time he worked for the company. However, the claimant did not notify the employer of the injuries prior to his termination or during his exit interview.

This case was referred to ISI’s Special Investigations Unit for work comp fraud on the basis of two red flags:

• The claimant reported the claim late (two months after termination)
• Video surveillance showed the claimant working in another construction job.

A full 26 minutes of surveillance was obtained by ISI, showing the claimant working at a construction site and operating a Bobcat. At no time did he display any restricted movement or hesitation: He climbed in and out of a large truck. He climbed on the bed of the truck. He opened and closed the rails to load and unload the Bobcat.

During the investigation, statements were obtained statements from the company’s owners and managers, saying the claimant did not report any work-related injury. He also did not display signs of restrictions, limitations or emotional distress.

In the initial deposition by the defense attorney, the claimant denied working or being able to work. When shown the surveillance videos, he admitted to lying.

The claimant was found guilty of one count of insurance fraud and ordered to pay $84,354 in restitution.

The estimated cost savings in this work comp fraud case includes the restitution amount plus the amount saved in not being required to pay temporary total disability to this non-injured worker, totaling over $150,000.

About Investigation Solutions, Inc.

Investigation Solutions, Inc. is our multi-line claims investigation company providing nationwide field investigation, surveillance and SIU services to the insurance, legal and self-insured communities. Learn more at Investigation-Solutions.com.