"For Your Peace of Mind, Let Us Uncover the Truth" CA P.I. Lic. 21673
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Workers' Compensaton fraud, otherwise known as claimant fraud, is probably one of the most talked about types of fraud. Butler & Associates Private Investigations has been providing investigative services to employers and insurance companies since 1997 to help combat fraudulent injury claims and the rising insurance premiums that result from these claims. If you feel that one of your employee's may have filed a fraudulent injury claim, we may be able to help expose the fraud and secure successful prosecution of the responsible party.
Workers' compensation fraud occurs when an employee knowingly and intentionally provides false information to collect benefits. False information could be an employee's claim that an injury was work-related when it was not, or the employee claiming to be injured when no injury was ever suffered in the first place.
While there is no definite procedure to immediately identify fraudulent claims, there are things to look for that may help in the decision to initiate surveillance of the suspect claimant. Red flags and signs of workers' compensation fraud include, but are not limited to, the following:
* Injury occurred on a Monday or a Friday. Statistically, more fraudulent injuries or illnesses are claimed to have occurred on these days.
* The claimant is a new employee. Statistically, newer employees file more fraudulent claims than those with longevity.
* There are no witnesses to the accident or injury.
* The claimant is a disgruntled worker. Angry workers have a built-in motive to file a fradulent claim, which is to get back at the employer. Denial of vacation time, demotions, or terminations have all been linked to fraudulent workers' compensation claims.
In addition to the above red flags, there are things to look for AFTER the claim has been filed and benefits are being collected that could indicate a fraudulent claim. These signs include, but are not limited to, the following:
* The employee or claimant is difficult to contact. This may be an indication that they have obtained another job or are involved in outdoor activity.
* Varying accounts of how the accident occurred. Discrepancies in how the employee desribed the injury to the employer as opposed to the doctor, or a conflicting witness account of the accident, may arouse suspicion of a fraudulent claim.
Video still from a Workers' Compensation fraud investigation. Our client reported that their injured employee, driving this pickup, claimed he was completely disabled from a workplace accident.
Video still recorded by Butler & Associates investigators showing the same injured employee (claimant) exhibiting mobility that both he and his doctor reported was too painful to perform.
Video still image recorded by Butler & Associates showing the injured employee engaging in activity and mobility that contradicted his injury claim.
Once a workers' compensation claim has been deemed to be suspicious, covert surveillance should be conducted to determine the validity of the employee's injury claims. Covert surveillance, when performed correctly, is non-intrusive and designed to protect the employee's right to privacy while gathering the necessary evidence. Butler & Associates Private Investigations utilizes a 2-person surveillance team on all workers' compensation fraud investigations to effectively secure the evidence, provide a comprehensive report and DVD, and offer remedies that could include both criminal and civil actions against the employee.
Butler & Associates charges $95 per hour to perform investigative work on all workers' compensation fraud investigations. This includes covert surveillance and AOE/COE interviews of the employee and witnesses. Our highly-trained investigators pay special attention to California state statutory restrictions, federal statutory restrictions, and case law. We avoid invasion of privacy issues to protect our clients from liability claims for unlawful surveillance, utilizing only court-tested and legal methods. All Butler & Associates investigators are required to attend the Contra Costa County (CA) District Attorney's Annual Workers' Compensation Fraud Seminar to ensure proper reporting, investigation, and criminal prosecution of workers' compensation fraud cases.
Video still image recorded by Butler & Associates showing the injured employee lifting a 100-pound ceramic toilet. This activity was in complete contrast to the doctor's findings and the employee's claim. The videotape captured on this date resulted in the termination of the workers' compensation benefits and initiated a criminal fraud case.