Worker Comp Claims, it’s Costly.

I received the call from a business owner, with a “crazy hunch,” that something wasn’t quite right with the letter they had just received. In the mail, he got notice from a Personal Injury Attorney asking if they would like to settle a claim made by an individual who had worked for them in the past, but it just didn’t seem right. They knew the person, and yes, he had worked for them. Yet, he was never an employee as he had stated to the Plaintiff Attorney.

The business owner contacted me, and I conducted the usual Q & A to determine what was there. We were able to uncover that, in fact, the individual was a contractor and did not fall under the guidelines of Georgia law to be compensated as an employee.

It is an inevitable that for most companies, an employee may get hurt on the job. However, it is what that company does next in the immediate future can mitigate a lot of time, money, and headache. Companies should begin by compiling any records of that person, previous injuries with claims, talk to coworkers for eye witness accounts, does the employee have a side job or part-time position elsewhere.  You see, fraudulent claims cost the US businesses in the neighborhood of $30-$40 billion each year in claims that should have never seen the light of day.

The possibilities for fraud are endless. As a result, employers have become more suspicious of accident claims. In fact, hiring a private investigator to track the employee is becoming more common in workers’ comp cases.

Read More About Worker Comp Fraud

Things to look for when you have had a claim against your company from an employee:

1. Was there a witness?

2. Was there any Refusal of Treatment?

3. Was there an unexplained delay in reporting the incident?

4. Did the injury occur just before termination or the end of contract?

5. Is the employee difficult to reach, or never available, while on leave?

6. Did the employee hire an attorney right away and/or are they pushing for a quick settlement?

There are a large number of indicators that would provide signs that the injury may not have actually occurred. The hiring of a Private Detective quickly can eliminate a great deal of costs that a company does not want to deal with. Skilled detectives are able to use trained eyes to evaluate details that others may skim by. Businesses are working to make money and provide jobs, not to spend money on frivolous lawsuits that have no merit. Trust me, the business will spend money. Lawyers, labor hours dedicated to the defense of the claim, and the company’s insurance may see a rate increase. 

Hiring a Private Investigator early into this scenario will eliminate the headaches by cultivating information such as:

1. Photo/Video documentation of the employee.

2. Detailed Record search

3. Surveillance

4. Interviews of previous employers.

5. Information request of local law enforcement. {contact me and I will tell you why this one is important}.

6. Interviews of current co-workers.

All this can lead to a successful defense of the claim and prevent the company spending unnecessary dollars to defend a fraudulent case. The case I referenced above, I gathered a great deal of info, submitted it to the very large Personal Injury firm, and the representing attorney quickly removed all hearings. Informed my client and their attorney that the case will be dropped.

I encourage you to look into any claim that you have suspicion on, and contact us for a consultation.

Georgia statute §34-9-19 reads:

Any person, firm, or corporation who willfully makes any false or misleading statement or representation for the purpose of obtaining or denying any benefit or payment under this chapter shall be guilty of a misdemeanor of a high and aggravated nature and, upon conviction thereof, shall be punished by a fine of not less than $1,000.00 or more than $10,000.00 or by imprisonment not to exceed one year, or by both such fine and imprisonment. Additionally, any person, firm, or corporation who violates this Code section may also be assessed the cost of investigation or prosecution, or both, in accordance with Chapter 11 of Title 17, relating to the assessment and payment of costs of criminal proceedings.

Additional Sources:

National Insurance Crime Bureau, “Workers’ Compensation and Medical Fraud”