INSURANCE FRAUD INVESTIGATIONS

Are you tired of paying higher insurance premiums than needed to run your business? Should your company investigate a claim? Insurance industry studies have shown that over 30% of Workers Compensation claims involve some degree of fraud. Amazingly, 12% of Americans questioned, responded that they did not feel it was wrong to exaggerate an on the job injury. A full 10% did not believe it would be dishonest to make an on the job claim for an injury suffered at home.

Why wait for your insurance company to start an investigation. Impact Investigations, Inc. offers you the alternative to take control of the situation. Our trained investigators have been very successful in obtaining information that will allow your insurance company to re-evaluate their position for settling the claims without thoroughly investigating the situation.

Impact Investigations, Inc. applies state of the art equipment and surveillance methods to determine if your employees are committing a fraud against your company. Every attempt is made in the pre-surveillance interview to gather as much information as possible on the suspected individual before a surveillance is initiated. After the patterns and background has been established surveillance cycles are conducted over pre-determined periods of time.

Here are some of the items that might indicate a suspicious claim:

The alleged injury occurs first thing on Monday morning.
The alleged injury occurs immediately before a possible termination or layoff.
The employee's medical providers or legal consultant have a history of handling suspicious claims.
The injury or accident occurred without any witnesses.
The employee's description conflicts with the medical history of the First Report of Injury.
The employee has a history of suspicious or litigated claims.
The employee refuses diagnostic procedures to evaluate or confirm injury.
Claimants are difficult to reach at home when they are allegedly disabled.
Employee delays reporting the claim without a reasonable explanation.
Groups of claimants utilizing the same doctors or lawyers.

If any one of these indicators should arise, be suspicious, and investigate. Call to set up a pre-surveillance conference and discuss your options for reducing your monetary exposure through surveillance.
 

WORKER'S COMPENSATION INVESTIGATION

Indications of Possible Fraudulent Worker's Compensation Claims Requiring Investigative Activities:

1. Claimant is never home when contacted by telephone - possibly working.

2. Claimant requests to be called at specific times - possibly working.

3. He/She has a history of cancelled physical therapy or doctor's appointments.

4. Information from other employees having knowledge of activities of claimant on Worker's Compensation - watch motivation for reporting the information.

5. Trends - friends and/or family members of claimant have been or are currently on Worker's Compensation.

6. Claimant has past history of claims.

7. Claimant has past record of injuries before hunting season or other special time of the year.

8. No loss of muscle tissue after prolonged period of receiving Worker's Compensation benefits.
*Key: train your medical personnel to report information to you.

9. Pregnant employee reports being injured on the job early in pregnancy. After birth of the child, comes back to work and alleges to have aggravated the previously reported injury. Result: enables her to stay home with her newborn baby - with pay.
 

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