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Pinnacol resources to fight workers' comp insurance fraud

January 19, 2021
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Many things change with the new year, such as the calendar and the date you write on your checks. One thing that stays the same is Pinnacol’s commitment to helping our policyholders fight insurance fraud.

You have reason to worry about this widespread problem. Workers’ compensation insurance fraud costs American businesses $6 billion each year, according to the Coalition Against Insurance Fraud (CAIF).

Fortunately, no matter what year it is, Pinnacol has loads of resources to help you identify and/or investigate insurance fraud.

What is insurance fraud?

Insurance fraud includes any act meant to defraud the insurance process. Common types of workers’ comp insurance fraud may include:

  • Injured worker fraud, such as misrepresenting a condition to secure workers’ comp insurance benefits.
  • Medical provider fraud, such as providing false information about patients.
  • Subcontractor fraud, such as presenting a fraudulent certificate of insurance.

Pinnacol can provide you with the support, tools and knowledge to deal with all kinds of insurance fraud. 

Pinnacol insurance fraud resources

Pinnacol’s special investigations unit (SIU) includes fraud, claims and field investigators with more than 200 years of combined experience. They can look into allegations of fraud related to injured workers, policyholders or agents by analyzing data, scrutinizing suspicious claims and following up on reported cases.

In addition to handling investigations, Pinnacol provides educational opportunities to help you recognize potential instances of fraud, including a guide to identifying a fraudulent certificate of insurance.


Our insurance fraud investigators in action

We take every fraud claim seriously because we know you do, too. You can feel confident in the quality of our investigations. They get results.

Last year, Pinnacol Senior Investigator Matt Heiderich assisted the Colorado attorney general’s office with securing a conviction by delivering evidence against a perpetrator who pled guilty to insurance fraud, forgery and attempts to influence a public servant.

This perpetrator entered the guilty plea because of the overwhelming proof presented against him, which was gathered by Heiderich and others. In recognition of his contribution, Heiderich became one of the first Coloradans to receive the International Association of Special Investigation Units Multi-Jurisdictional Investigative Excellence award, earning notice as part of a larger team.

Our thorough investigations can protect you from paying fraudulent claims and keep your premium rates down. 

What should you do if you suspect fraud?

Contact your agent immediately if you suspect fraud. If an independent contractor submits an insurance certificate that appears fraudulent, you should also contact the carrier listed on the certificate. Please call 303.361.4000 to reach the SIU and report the suspected fraud.

Pinnacol Assurance assumes no responsibility for management or control of customer safety activities. Please ensure your business meets the requirements of all federal, state, and local laws, regulations, or ordinances related to workplace safety.

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