Vanguard

Worker's Compensation Investigations

Insurance fraud investigations in the workplace and disability claims encompass a range of deceptive practices, each addressed with specific investigatory techniques: 

Workplace Injury Fraud: This involves investigating allegations of fabricated or exaggerated injuries at work. Investigators typically review medical records, surveillance footage, and employee histories to determine if injuries were indeed sustained in the workplace and if their severity matches the claims made. 

Pre-existing Conditions: Insurers must verify whether a claimed injury was genuinely caused by a workplace incident or if it was due to a pre-existing condition. This often requires a detailed review of the claimants medical history and consultations with healthcare professionals to assess the nature and origin of the injury. 

Moonlighting: This type of fraud investigation checks whether claimants who are receiving disability benefits are secretly working another job, which would violate the terms of receiving such benefits. Techniques include surveillance, social media monitoring, and employment database searches to uncover undisclosed employment. 

False Witness Claims: Investigating the credibility of witnesses involves verifying their statements and assessing their potential biases or motivations to lie. This can include cross- referencing witness accounts, examining their background relationships with the claimant, and analysing any inconsistencies in their testimonies. 

Each of these investigative categories requires a combination of fieldwork, digital investigation, and legal scrutiny to ensure that only valid claims are approved, thereby protecting the integrity of insurance and disability programs. 

Require professional expertise to gather and present evidence? Contact us today!

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