An adjuster was assigned a late report specific arm injury claim by a new employee, who was believed to also be self-employed. She referred the claim to Investigation Solutions. We found social media posts of the claimant’s martial arts. Others showed construction work done just before and after his date of injury. The claimant had… Read More
workers' compensation fraud
“Badly injured” construction worker found on the job
Yet another construction worker with a back and knee injury was not getting better as expected. He said he couldn’t walk, lift, climb, etc. Rest and treatment did not help. (This is statistically improbable.) Surveillance found the man driving 60 miles from his home to work at a construction site, an activity clearly inconsistent with… Read More
Surveillance revealed “injured” worker was employed elsewhere
A contractor was hurt on the job and filed a claim for back and leg injuries. When Investigation Solutions was asked to look further into the claim, the senior investigator first tried the injured contractor at home, but he wasn’t there. Our investigator went to the claimant’s doctor’s office and found a vehicle registered to… Read More
Medical clinic without a medical doctor equals fraud
On behalf of an insurer, American Claims Management was getting California workers’ compensation claims with treatment at a medical clinic outside their MPN (medical preferred network). ACM also received invoices for interpreters and suspected medical fraud. The “injured” workers reportedly saw multiple doctors at the clinic, but the reports were inconsistent: One patient was found… Read More
“Injured” worker found guilty of fraud and ordered to pay restitution of $84,304
A worker injured in 2012 committed workers’ compensation fraud when he said his arms, shoulder, back and knee were injured from driving a truck. However, he got better and forgot to tell his doctors, his adjuster or his attorney. IS caught him working while claiming to be disabled. Not only was he working – he… Read More
ISI obtains conviction in work comp fraud case, saving client $150,000
Working on behalf of our carrier client, we filed a work comp fraud case with the District Attorney, obtaining a conviction of a former employee hired as a driver. The driver filed a fraudulent claim after he was terminated. He was found guilty of insurance fraud and ordered to pay more than $84,000 in restitution. The… Read More