Worker's Compensation Investigations
Workers’ compensation is one of the most important benefit systems available to American workers. When legitimately injured on the job, employees are entitled to medical treatment and, in many cases, wage-replacement benefits. In exchange, employers receive protection from civil lawsuits, creating a streamlined and equitable claims system.
When the system functions properly, it benefits all parties. Unfortunately, workers’ compensation fraud has become a significant and growing problem within the United States insurance industry.
According to the National Insurance Crime Bureau (NICB), fraudulent workers’ compensation claims cost insurers and employers tens of billions of dollars annually, with losses in New York alone estimated in the billions each year. Fraud may originate from claimants, employers, medical providers, or legal professionals, often requiring specialized investigative expertise to detect and prove.
The Global Intelligence Bureau provides professional Workers’ Compensation Fraud Investigations for insurance carriers, SIU units, TPAs, self-insured employers, and defense counsel throughout New York, New Jersey, Florida, as well as nationwide and internationally.
Employee-Based Workers’ Compensation Fraud
While many claims are legitimate, employee-based fraud may include:
These cases often require professional surveillance, activity checks, medical canvassing, and background investigations to establish inconsistency between claimed limitations and observed behavior.
Employer-Based Workers’ Compensation Fraud
Fraud may also originate on the employer side, typically involving attempts to reduce premiums or avoid liability, including:
Such fraud exposes insurers to unexpected losses and may leave legitimately injured employees without coverage.
Medical Provider & Attorney Fraud
Unscrupulous medical providers and legal professionals may also exploit the workers’ compensation system through schemes such as:
These complex schemes frequently require long-term investigations, undercover operations, financial analysis, and coordinated surveillance.
Investigative Solutions
The Global Intelligence Bureau conducts comprehensive workers’ compensation fraud investigations utilizing a combination of:
Our investigators are highly experienced in documenting court-admissible evidence demonstrating fraud, misrepresentation, or criminal conduct. Our findings are routinely used for claim denial, benefit termination, SIU referrals, civil recovery, and criminal prosecution.
Criminal & Civil Impact
Workers’ compensation fraud is a criminal offense and may result in felony charges, restitution, fines, and incarceration. Our investigations have supported both criminal convictions and substantial financial recoveries for insurance carriers and self-insured entities.
Having worked investigations involving claimants, employers, medical providers, and organized fraud networks, we understand how these schemes operate and where to uncover the evidence necessary to dismantle them.
Service Areas
We provide Workers’ Compensation Fraud Investigations throughout:
If your organization requires a professional Workers’ Compensation Fraud Investigation, contact The Global Intelligence Bureau for a confidential SIU or claims consultation.
