Insurance Company Fraud

Legitimate insurance claims are a part of doing business and retaining employees. If you suspect insurance fraud against your business is taking place, a thorough investigation should be completed to protect your company’s assets.

Insurance fraud can take place in a variety of forms, most commonly workers compensation fraud and fraudulent claims for personal injury on your property, so learning more about the signs can help keep your business secure. Identifying and pursuing a penalty for insurance fraud can save your business money and prevent future issues in this area.

Workers’ Compensation Fraud: An Overview

An employee injury at the workplace is never a good situation, so insurance can be an essential part of the financial stability of a business. In some cases, however, a worker’s compensation claim turns out to be a case of fraud. One type of fraud involves false or exaggerated medical or injury claims. Another type of workers compensation fraud involves an employee working another job while on leave from another company. If the injury claim is suspicious due to circumstances or timing, an evaluation by a private investigator could be advantageous.

Exaggerated Injury Claims

Claims that are suspected to be false workers’ comp cases are not always complete fabrications. In some cases, injuries do occur but are exaggerated or the employee should be cleared to work. If fraud is suspected, it can be helpful to seek the services of a professional investigative team. Fraud can be difficult to prove, but there are some key signs to consider after a claim has been filed.

  • Employee is working with a physician who is notorious for suspicious claims.
  • Treatment dates do not match work injury claim dates.
  • Treatment seems extreme or prolonged for type of injury claimed.
  • Paper trail of billing seems conflicting, is missing items or are all photocopies.
  • Multiple doctor opinions are sought until desired diagnosis is gained.
  • Bills seem to be exaggerated or lacking essential details.

Suspicious Timing

Employee protection policies and laws are put into place to stop unfair employee treatment at the workplace. Unfortunately, some individuals fabricate workplace illness or injury to enact these policies when they should not qualify. If the timing of the employee’s suspicious incident coincides with disciplinary action, soon after employment begins, after the employee has expressed displeasure with the job or if the employee has recently threatened to quit, an investigation could be warranted.

Multiple Income Streams

One of the ways an employee can commit insurance fraud for workers’ compensation is by receiving benefits from one employer and then earning income through another employer. This double-dipping can occur for a long period of time if neither employer is aware of the other. In some cases, the fraud or fraud attempt is discovered simply by the new employer reaching out to the original one for a reference. In other cases, the employee’s lack of availability can be a red flag. The adjuster could have trouble reaching the employee during normal working hours, or the employee could continuously cancel appointments without explanation.

Personal or Bodily Injury Claim Fraud

Another common type of insurance fraud commonly committed against businesses is a customer or client personal injury claim on the premises. Modern technology like security cameras and even customer cell phone video recordings can help weed out some of the false claims, but other cases are harder to prove without investigative help. False injury claims can happen on the physical business property itself or with business-owned property such as motor vehicles.

Signs of Fraud

Like worker’s compensation claims, one of the most common ways to commit insurance fraud against a business is through exaggerated injuries. Minor injuries that require long-term or excessive treatments can be suspicious. If an individual is working with an attorney or a physician who has a history of frequent suspicious insurance claims, this can be a red flag.

Slip-and-fall claims on your business property that occur without any witnesses or conflicting or unusually detailed witness observations are good cases for further investigation. In these cases professional investigators look for patterns of behavior, prior claims and a history of working with the same physicians and attorneys that have resulted in settlements in the past.

Insurance Fraud Investigations To Protect Your Business

Insurance policies are put into place for the protection of your business and your employees. These policies are important to the financial well-being of your company because they help keep the business secure in the case of legitimate illness or injury claims.

In some cases the business owner might suspect insurance fraud, especially with common false claims like cases of workers compensation fraud or bodily injury claim fraud. When that occurs, it is important to consider professional investigative services to help determine if fraud has occurred and what, if any, penalty for insurance fraud should take place. If you believe your business is the victim of insurance fraud, contact Beau Dietl & Associates today.