Recently, ICW Group’s Special Investigations Unit (SIU) uncovered a significant fraud attempt stemming from what initially appeared to be a routine workers’ compensation mileage reimbursement.
A 37-year-old baker had an open workers’ compensation claim after she sustained a burn injury to her foot in the fall of 2024. As part of her recovery-related expenses, ICW Group issued a mileage reimbursement check for $19.70 a couple of months after the injury. However, a couple of weeks after the check was issued, ICW Group’s SIU was notified of suspicious activity involving that very check. It had been altered to reflect a new amount of $3,019.70, and was successfully deposited—netting an unauthorized gain of $3,000.
An in-depth review by the SIU revealed key discrepancies:
- The payee’s name was changed from the injured worker to her boyfriend.
- The address was also altered on the check.
- The endorsement signature did not match those on previously issued checks.
When contacted by the claims examiner, the worker claimed she was unaware of the alteration and alleged that her boyfriend may have modified the check without her knowledge. SIU investigators worked closely with the examiner to verify the claimant’s statement.
After compiling all of the evidence—including altered documentation, banking records, and statements—SIU referred the case to law enforcement. Ultimately, the boyfriend was charged with four felony counts, including grand theft, forgery, and insurance fraud.
Even small reimbursement checks can lead to significant fraud. Thanks to collaboration between SIU and ICW Group’s Claims department, a coordinated response prevented further losses and resulted in appropriate legal action.
Let this serve as a reminder: attention to detail matters, and vigilance at every step of the claims process plays a critical role in safeguarding the integrity of our system.
