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Workers’ Compensation Fraud

Workers’ compensation one of the most important benefits available to the American worker. In the event of an on-the-job injury, worker’s compensation covers the cost of the injured employee’s medical treatment, and, frequently, compensates the employee for wages lost during his recuperation.

The first state workers’ compensation laws were enacted in the first decade of the 20th century. By 1949, all 48 states (and the federal government) had workers’ compensation plans.

Workers’ compensation operates on the principle that both negligence and fault are irrelevant to the settling of a claim. In most cases, acceptance of a worker’s’ compensation settlement means that the employee relinquishes his right to sue the employer for negligence. The result is a civilized way to handle workplace injuries: workers are guaranteed equitable and prompt compensation, and long legal actions (possibly resulting in exorbitant damages) are avoided.

Most workers’ compensation claims involve honest employees legitimately injured on the job, and honest employers who have purchased sufficient coverage. The system generally works, and, when it does, it is to everyone’s advantage.

However…

Workers’ compensation fraud has attained near-epidemic proportions in the United States. Recent estimates by the National Insurance Crime Bureau state that, nationwide, the annual cost of fraudulent workers’ compensation claims is in excess of $30 billion, with between $1 billion and $3 billion of that coming from the State of California.

Workers’ compensation fraud can come from the employee, from the employer, or from the medical personnel treating an injured worker. In all three cases, the services of a licensed private investigator are the best way to detect and prove the fraud and then to bring the case to trial.

John A. DeMarr PI has had extensive experience investigating all types of workers’ compensation fraud. We know how to recognize an insurance scam – and we know how to collect the evidence to prove one.

Types of Fraud

The image of workers’ compensation fraud that first comes to mind is that of a person staggering around in a back brace, only to start moving pianos and heavy furniture up flights of stairs when he thinks no one is looking. (At John A. DeMarr, we have actually handled such cases. (See our success stories for details.) While the fraud in that case is flagrant, the abuses of the system on the employee’s side can also include:

  • Hurt off the job (making a workers’ compensation claim for an injury that was not incurred while working)
  • Fake injuries (filing a claim for an injury that doesn’t exist)
  • Old injuries (filing a claim for an injury that dates from before employment began)
  • Inflated injuries (exaggerating an injury so as to file a larger claim)
  • Malingering (exaggerating the amount of time needed to recuperate from an injury.)

On the employer’s side, abuses of the workers’ compensation system are usually either efforts to reduce insurance premiums, or to avoid paying claims. Some examples of employer fraud are:

  • “Safer” jobs (attempting to reduce premiums by maintaining that a workplace is less hazardous than it really is)
  • Hidden employees (avoiding premiums by such scams as pretending salaried employees are independent contractors for insurance purposes)
  • Avoiding coverage (by simply not paying premiums altogether.)

These premium scams are just as fraudulent as an employee faking an injury. Employees with legitimate claims may come up against an improperly insured employer, or discover too late that, while they assumed themselves to be covered, they were not, and that any chance they had at recouping their medical costs and lost wages would require taking their employer to court (and the need to prove fault or negligence.)

Unscrupulous doctors, medical providers and lawyers have their own set of scams for bilking the workers’ compensation system. Their fraud tactics can include:

  • Inflated injuries (exaggerating the extent of a patient’s injury in order to charge for unnecessary medical procedures and prescription drugs)
  • Phantom injuries (billing workers’ compensation for injuries that never occurred)
  • Bogus lawsuits (suing workers’ compensation on behalf of patients pretending to be injured, on the assumption that the insurer would rather settle than go to trial)
  • Illegal kickbacks (paying recruiters to bring in uninjured workers to participate in workers’ compensation scams)
  • Fake clinics (billing workers’ compensation for treatments administered at a facility that does not exist.)

The Private Investigator as Solution

Workers’ compensation is fundamentally an honor system – and therefore falls victim to abuse and fraud all too frequently. The solution? Bringing in a private investigator skilled in cases of insurance fraud.

The classic workers’ compensation investigation calls for the surveillance of a purportedly injured worker so as to capture evidence of him moving a piano when he claims he’s unable to move out of bed. At John A. DeMarr PI, we have performed countless investigations of this type. We are highly competent at this type of surveillance, and possess the know-how and equipment to obtain evidence to document these types of fraud. Our investigations have also led to the exposing of crooked doctors involved in workers’ compensation scams

We are also capable of performing the more complex investigations into the other types of workers’ compensation fraud. We have worked on behalf of employees whose legitimate claims were not being paid, and, through undercover operations, have obtained evidence of massive fraud (including overprescribing of controlled substances) in bogus “medical mills”.

Over the years, we at John A. DeMarr PI have learned all the ins and outs of workers’ compensation frauds and scams. Having worked on both sides of the field, we know both where and how to look to obtain the evidence necessary to prosecute fraud and obtain financial restitution for our clients.

Remember, too, that workers’ compensation fraud is a criminal offense, and can result in very real jail time. Our investigations have helped obtain criminal convictions as well as in monetary settlements.

Workers’ compensation is a valuable employee benefit that has protected American workers for over a century. Good though the system is, it can go awry. When it does, your best course of action is calling in a private detective – and licensed private investigator John A. DeMarr PI is one of the best options in California for fraudulent workers’ compensation claims.

If you suspect you are party to any type of workers’ compensation fraud, please call our offices at 877-432-6277 for a free consultation and quote. You may also contact us via email using the convenient form below.

Workers’ Compensation Fraud – Free Consultation
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