Workers’ compensation fraud isn’t always obvious. Sometimes, it starts with small inconsistencies that, when viewed together, tell a much bigger story.
In a recent case, an injured worker reported wrist and back injuries following a workplace accident and began receiving medical treatment and temporary disability benefits. As the claim progressed, however, information surfaced that raised questions about whether the individual’s reported circumstances and limitations matched their actual activities.
Identifying the inconsistences
The investigation identified several significant discrepancies. Surveillance and social media activity appeared inconsistent with the limitations being reported. Investigators also uncovered information regarding concurrent employment that had not been disclosed, as well as another workers’ compensation claim involving overlapping dates and similar injuries.
Additional information indicated the individual remained actively involved in veterinary-related activities, including work associated with a pet rescue and employment as a veterinary technician instructor, during a period in which temporary disability benefits were being collected.
Looking at the bigger picture
Taken together, the inconsistencies warranted a much closer look. By that point, more than $56,000 had been paid on the claim. ICW Group’s Special Investigations Unit (SIU) referred the matter to local law enforcement, and the investigation ultimately resulted in felony charges filed.
Why it matters to employers
Cases like this demonstrate the important role employers can play in identifying potential workers’ compensation fraud. Employers often have firsthand knowledge of their employees, job duties, outside employment, and other circumstances that may not be immediately visible to a claims professional.
That doesn’t mean employers are expected to investigate suspected fraud themselves. Instead, sharing relevant information or concerns allows Claims and the Special Investigations Unit to determine whether further investigation is appropriate.
Early communication can help identify questionable activity, reduce unnecessary claim costs, and help protect the workers’ compensation system for the employees who legitimately need it.
The takeaway is simple: If something doesn’t add up, speak up. A seemingly small piece of information could be an important part of a much bigger picture.
