Fraud Investigation Checklist — Get involved, manage the process!

Many employers let the adjuster take charge of the investigation, but the employer should stay involved. Here are a few considerations:

  1. Make sure the investigator is licensed, bonded and insured, especially if you hire them directly, as is the case with self-administered companies.

  2. Investigate over a few days, a few weeks or a few months rather than a shorter time period. I had one investigation that took one YEAR, and we observed the employee in 3 states, until we FINALLY found that his passion was car racing — which he only did in one location. So, make your investigations broad rather than narrow. Don't be "penny wise and pound foolish." That investigation cost $10,000 but we settled the claim for $6,000 instead of $100,000. And, it was a HUGE deterrent to future fraudulent claims.

  3. Ask the investigator to break up five days of surveillance over several weeks, catching a work day, early, late, and the weekend.

  4. Find out if the investigator has substitute vehicles or multiple investigators. If the employee knows they are being watched, it's helpful to have more than one vehicle.

  5. Make sure the investigator knows the area well. Try to avoid out of town investigators.

  6. Tell the investigator when the claimant's next doctor's appointment and weekly meetings are… these are good points for the investigator to pick up the claimant.

  7. Make sure the investigator has a photo and accurate description of the claimant so they are watching the right individual. Sounds funny, but it happens all the time… they watch the wrong person.

  8. YOU should read the report carefully because YOU may be able to pick up facts the investigator is unfamiliar with. For example, I had an employee that was out of work. The investigator followed him to the VA every day at 7 AM, and to the bank of Thursday at noon. He concluded the individual wasn't working. Dah, sure looked to ME like he might have been cashing a VA paycheck at noon — and upon further investigator we learned he was, but the investigator drew an inaccurate conclusion.

  9. Make sure the investigator knows the alleged injury and medical restrictions, so they can watch for activity that uses those body parts and actions.

  10. Stay in touch with the investigator and/or adjuster to monitor the progress of the investigation. If it's not being handled to your liking, or if you have questions, SPEAK UP. Remember: it's YOUR money!

  11. Tell the investigator anything that is "new" like a new hairdo, new car, new person living in the residence, etc. Let him/her know these "new" things immediately.

  12. Check your Account Service Instructions to make sure they include that you are to receive copies of reports and be kept in the loop on updates from the investigator. If you aren't sure how to phrase your account instructions, CALL ME, and I'll help you. If you don't know what Account Instructions are, or where to find them, CALL ME QUICKLY! I've been where you are, I'll help you learn the ropes.

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Author Rebecca Shafer, President of Amaxx Risks Solutions, Inc. is an attorney and national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.  Contact:




Workers Comp Resource Center Newsletter

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