Our Special Investigations Unit (SIU) saves policyholders millions of dollars in questionable claims costs each year by investigating injured workers, employers and medical providers suspected of workers' compensation fraud.
Injured worker fraud
Includes working while collecting benefits and making false medical statements in order to receive benefits.
This costs all employers. Not only does it give some employers an unfair advantage, but it also affects the premium rates all employers pay. Examples of employer fraud include underreporting payroll, misrepresenting the nature or volume of a company's business and altering certificates of insurance.
Medical provider fraud
Includes actions such as charging for visits, care or treatments not received by the injured worker, as well as falsifying patient information.
Fraud can happen anytime and anywhere. Here are a few things to look for*:
A new employee files a claim
An injured worker hires an attorney the day of the accident
The accident story changes often
There is a long delay between the accident and the filing of the claim
The claim coincides with a layoff or termination
*It should be noted that the above could occur in the normal course of business and may not necessarily be an indicator of fraud.
If you hire subcontractors, make sure their Certificate of Insurance is valid. The best way to do this is to get it directly from the issuer — which could be us, one of our affiliated insurance agents or another carrier.