Insurance costs rising? Corporate culture affected? Frustration? Decrease in production? Increased training costs?

These days as we meet with clients we seem to always hit a hot button when we get on the topic of Workers’ Compensation. The rising cost of Workers’ Compensation Insurance really impacts small businesses.

The main frustration that our clients have is that so many claims are filed and the insurance company would rather settle the claims than aggressively fight them off. Companies want to send a message to their employees that Workers’ Compensation claims that are fraudulent will not be tolerated. A settlement check from the insurance company sends a contrary message. We encourage clients to work in cooperation with their insurance carrier and investigator to develop the evidence required to defend claims.

Workers’ Compensation claims drastically impact a businesses ability to provide raises to employees, improve systems and keep them profitable.

We find that it is important to constantly remind employees of the negative effects of filing fraudulent Workers’ Compensation Claims. In fact employers often bring us in to present to their employees about the effects of Workers’ Compensation claims on the business. Additionally, during our presentations the employees are reminded that their employer will be thoroughly investigating all claims. We also recommend that employers conduct thorough pre-employment background checks on prospective and current employees.

What investigative services can be utilized to stop Workers’ Compensation fraud? This is a great question with a complex answer. First and foremost we would recommend that all employers make their employees aware of the need to report any and all claims immediately. We also recommend that personnel files are kept up to date in the event that a post-claim investigation is required. The most useful information in a personnel file to HR professionals, claims examiners and investigators are; current photographs, drivers’ license number, emergency contact person, updated address, job descriptions and training certificates.

Interviews/Statements- Commonly referred to as AOE/COE investigations can be conducted at the first notice of any injury/claim to obtain information from witnesses and the injured employee regarding the injury. This is a great way to document the specifics and let the employee know that injuries/accidents are treated seriously. Additionally information obtained in the AOE/COE investigation can be used later on should evidence of fraud come up.

Activity Checks– Discreet field investigations to determine the employees activity level. These checks involves checks can involve discreet interviews with neighbors to determine the employees activity level and determine if the subject is employed.

Surveillance– Discreet field surveillance can be conducted to obtained video recorded evidence of the injured workers activity level, evidence of employment and or evidence of actual injury.

Subrogation (Third Party Liability)- Investigation aimed at determining if a third party has any exposure to the liability. This type of investigation is very common when the injury was caused by machinery or equipment that is not owned or maintained by the employer.