Compensation Fraud

WORKERS COMPENSATION FRAUD

Workers compensation is insurance that provides medical benefits and wage replacement to employees that were injured on the job in exchange for liability not pursuing a lawsuit. Workers compensation fraud, on the other hand, is when an employer, claimant or healthcare provider lies to gain money, advantage, and other benefits. There is a common misconception that workers compensation fraud only happens on the employee’s end, but that is not always the case. 

Insurance fraud is one of the most expensive and common types of fraud, costing billions of dollars each year in damages across the country to corporations. Most companies never pursue insurance fraud investigations, making themselves vulnerable to fraudsters and potentially massive financial losses. An insurance fraud investigator examines all aspects of insurance claims to ensure the claim is valid and authentic. If any suspicious activity or fraud is uncovered the investigators at Marco Investigations will find the evidence to defend your business or organization against these fraudulent claims, so you are not paying out funds unnecessarily.

How insurance fraud is conducted:

  • Claimants will exaggerate the value of actual damages, overstating the claim to garner more money from the insurance carrier than what is indeed due. 
  • Insurance fraud can be carried through participating parties, with evidence that is fabricated by one witness or many witnesses and even with doctors exaggerating the seriousness of an injury to keep the injured in the “system.” 

In five years alone, under the Fraud Enforcement & Recovery Act, the government collected $23 Billion.

Marco Investigations has over 10-years of experience in insurance fraud investigation and testimony.

Marco Investigators puts their team in action utilizing the right surveillance equipment for the job. The investigators examine the evidence of the case, interviews witnesses, records submitted and follow up on the claimant’s filing and other means to get the case done. This in-depth exploration not only proves or disproves that the claim is legitimate but also gives you concrete, tangible evidence that you can use in court or stop payment in the case of fraud.

According to the U.S. Bureau of Labor Statistics, employer costs for employee compensation averaged $35.28 per hour worked in June 2017. Wages and salaries averaged $24.10 per hour worked and accounted for 68.3% of these costs, while benefits averaged $11.18 and accounted for the remaining 31.7 %. Total employer compensation costs for private industry workers averaged $33.26 per hour worked where wages and salaries averaged $23.15 or 69.6% of total compensation and benefit costs averaged $10.11 or 30.4%. 

Contrary to common belief, workers compensation fraud doesn’t solely consist of employees lying about or exaggerating their injuries as fraud can involve both employees and employers.

Employee Fraud May Involve

  • Injury while off of work
  • Financial stress at home
  • Injuries with no witnesses
  • Delays in reporting injuries
  • Injury concurrent with termination
  • Filing multiple claims – at times with multiple businesses 
  • Delays in seeking medical treatment and/or missed appointments

Employer Fraud May Involve

  • Denial of valid claims
  • Misclassification of workforce 
  • Late issuance of disability checks
  • Refusal to purchase insurance for employees
  • Making examples of employees who have submitted claims
  • Ghost Policies to independent contractors who are actually employees

If you’re an employee or employer suspicious of someone committing compensation fraud, consider hiring a private investigator to confirm suspicions before accusation – better to be safe knowing your suspicions are true then falsely accusing someone.  A trained private investigator, with the experience and training in the field, will conduct the research you need to correct the wrong and stop the bleeding.  The investigator will provide proof that will assist in prosecuting your case in efforts to cut off illegal workers compensation claims and can validate the findings in court if necessary. 

Call Marco Investigations today to speak with one of our Workers Compensation Investigators at 

(209) 410-0029 to receive a no-cost, confidential consultation with one of our licensed Private Investigators about your surveillance needs. Let our experience work for you.