How Can a PI Uncover Worker’s Compensation Fraud?


Worker’s compensation fraud hurts everyone. According to the Texas Department of Insurance, $800 billion is lost annually to fraudulent insurance claims. This money is taken out of the pockets of the people who pay higher costs for everything from goods and services to insurance premiums.

Worker’s compensation fraud occurs when a person willfully makes a false statement in order to receive worker’s compensation benefits. People who commit worker’s compensation fraud wrongly believe that this is a victimless crime against a too-big-to-fail insurance company.

Some feel entitled because they’ve dutifully paid insurance premiums without receiving any “benefit.” They see a claim as a quick way to make money without getting caught.

People often create trails of telltale clues when perpetrating worker’s compensation fraud. While these clues alone can’t prove insurance fraud, they can raise important questions that must be investigated. Take a look at five signs that an employee is committing worker’s compensation fraud.

1. Suspicious Timing

“Perfect timing” for an injury can be a sign of fraud. For example, an injury may occur just before an anticipated layoff. Worker’s compensation claims can also spike artificially around strikes, the conclusion of big projects that were keeping a company afloat, or the tail end of seasonal work.

2. Lack of Witnesses

Employees who are fabricating worker’s compensation claims are unlikely to recruit fellow workers to help them lie. This is why an unwitnessed accident is more likely to be fraudulent.

It can be a red flag when an employee is injured at work without witnesses. In addition, these unseen incidents are often accompanied by descriptions that don’t logically align with the nature of the reported injury.

3. Delayed Reporting

A lag in reporting an injury is a red flag. Most employees who report an injury days after it happened don’t have reasonable explanations for why they hesitated to tell someone in the workplace about what happened.

“Monday morning” reports are common. An employee may wait to report an injury that supposedly occurred on a Friday until Monday morning. While a “Monday morning” report isn’t reason enough to suspect fraud, there’s a high likelihood that an employee woke up on a Monday morning seeking a way to avoid showing up to work for another week.

4. A History of Claims

Some fraudsters are chronic fraudsters. They may have patterns of making suspicious worker’s compensation claims peppered throughout their work histories.

While having a history of claims isn’t concrete proof that a person has bad intentions, a history of contested or litigated claims could confirm the need to scrutinize new claims.

5. A Checkered Approach to Medical Care

People with legitimate injuries are often eager to receive diagnostic care as the first step to getting on the road to recovery. Claimants fabricating their injuries may refuse diagnostic procedures that could confirm their injuries.

Those who do seek diagnostic care may seek it from dubious sources. People who are lying about worker’s compensation injuries will often seek out medical providers with histories of managing suspicious claims.

How Does an Arlington Private Investigator (PI) Uncover Worker’s Compensation Fraud?

An Arlington worker’s compensation investigator can do a deep dive behind the “smoke and mirrors” technique a lying claimant is using to try to steal money.

Trained in inconspicuously observing and reporting within the confines of the law, an Arlington PI helps insurance companies and employers uncover the truth about invalid claims stemming from exaggerations, lies, or repetitive filing. These are some of the methods used by an Arlington private investigator:

  • Video surveillance techniques capture the physical activities a claimant participates in when “nobody’s looking.”
  • Online surveillance techniques monitor social media posts to spot actions conflicting with the information on a worker’s compensation claim.
  • Striking up a conversation with the claimant under the guise of being an “ordinary person” on the street. This provides an opportunity to get the claimant to discuss their injuries candidly without the presence of an attorney.
  • Interviewing colleagues of the claimant.
  • Interviewing accident witnesses.
  • Gathering physical and digital evidence that invalidates claims.
  • Conducting background checks to uncover patterns of fraud.
  • Investigating the claimant’s medical and employment records.

Save Your Finances From Fraudsters Today with Alliance Investigations

An Arlington worker’s compensation investigator gathers hard evidence to confirm the validity of a suspicious compensation claim. Stop fraud in its tracks! Book a case evaluation with Alliance Investigations, a PI specializing in worker’s compensation fraud!