Five Things to Do When Investigating Workers Compensation Abuse

5 Steps to Take When Asking Your Insurance Company to Investigate Fraud

There’s nothing funny about an employee faking an injury. However, perhaps looking at an example in a funny way might help in understanding how to request an in-depth investigation.

1. Start your email to the insurance company with the claim number, your contact information and a carbon copy to your supervisor.

2. We suggest you get right into the meat of the problem after that. Write, for example:

“As we discussed, I want you to investigate Mr. X’s claim in-depth. A co-worker advised us he was bragging about the five-point buck he shot last weekend when he went hunting with his buddies in northern Michigan. He was also observed by another employee riding ATVs with his son this past weekend. Mr. X has told me he cannot drive, sit, stand or walk for more than 10 minutes. Obviously, hunting and riding ATVs is at odds with his inability to perform any type of work.”

3. Next, ask the insurance company to:

“Retain a reputable firm to perform a sub-rosa investigation and videotape Mr. Smith’s activities. Tell them you are authorizing 15 hours of investigation divided into 3-hour increments. Require the investigator to telephone you at the end of each 3-hour period and if claimant is not seen after 2 hours, break off and continue later.”

4. Have a copy of the investigation report sent to you once the investigation is complete and then the company (you) can determine if additional evidence is needed. (workersxzcompxzkit)

5. Let the insurance company know you would like to be informed of developments and thank them for their cooperation in a timely manner. Restate your phone number.

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.