workers' compensation fraud

An ACM senior adjuster received a head and neck injury worker’s compensation claim. The employee, who had only worked for the company for five days, reportedly passed out and fell at work. He claimed headaches, sleep problems and depression were a result of the fall. He denied priors, but the Insurance Services Office showed a… Read More

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

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

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

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

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