Hiring a Private Investigator to Work on Workers Comp Fraud

Joe the Glazier filed his workers comp claim four months ago. You are sure he is working somewhere off the books, and your insurance carrier says they cannot do further investigation. You decide to take matters into your own hands and hire the retired cops from Law & Order and CSI. You know for sure that Joe is committing fraud, and you will prove it...maybe.

Workers comp fraud is when a person spends more time on comp than is needed, or incurs more medical costs than needed. The medical costs are by far the more expensive of the two options. It is out of the realm of a basic glass company to prove that a medical provider is acting fraudulently.

You can prove that Joe is stealing time, and that would bring his medical bills under the microscope as well.

You are 99% sure Joe is a fraudster. You call your insurance carrier's fraud unit, and after three days of calling, they finally tell you that they can not take on this case. It costs about $5,000 a week for a covert investigation. If Joe the Glazier is collecting $600 a week in comp, the insurance company just will not commit the resources. On-the-other hand, if Joe is putting in thousands of dollars of medical bills as well as he weekly stipend, then they will go after him. More often then not, unless Joe is part of a huge area-wide fraud, he will be ignored by the carrier.

You want to hire a PI, a private investigator. Your personal attorney is the best resource for a couple of names of investigators. Your attorney will try to talk you out of this...it is usually not a good investment, but you don't care. The principal of the fraud has you angry. You can also check the yellow pages or the Internet. Forget what you see on TV. Most investigators are retired cops and will only act legitimately.

Treat this as if you are shopping for a vendor. Interview one or two people and then make a business decision on which can help your glass company. When you do hire one, expect to pay between $500 and $1000 a day, plus expenses. Don't think you will go for one day's bill and catch someone in fraud. It takes more than one observation to make a judge believe there is fraud. You have to show that Joe is working every day, at the task he did for you, but for someone else. Joe can, and will say, that if you saw him for one day, that he was just helping a friend, and testing how strong he is so he can come back to work for you.

A good investigator will explain this up front, explaining why they need a five-day retainer. Give the investigator as much info as you have, don't tie his/her hands with weak information. If you can't give the investigator a good starting point, your bill will run-up and choke you. A good investigator will try following Joe at different times. Early morning one day; afternoon and evening the next. Joe may be working part-time, two days a week, and you start investigating on his off-days. The investigator should know what type of video and other evidence to get. The PI should give you a daily short report as to his status, and a weekly complete report. It does not make sense to go longer than a week.

80% of investigations bring in no results. This is what I was told when we hired an investigator on one case. And we fell into the 80%, with an expensive thud.

But let's be optimistic...you do get results that show Joe is working. Now, what do you do? You call the insurance company and they yawn. The legal costs to bring this to their attorney to then go to court, are again, thousands more than the $600 a week Joe is getting. They can't be bothered. You now call the local district attorney, saying you have proof of this fraud. If you catch them on a day when white-collar crime is being looked at, you may get a case. It depends on the political climate in your area...are there more violent cases that need to be worked on?

You go through all this, and hit three different brick walls. Is it worth it?

That's up to you and your budget. If you are sure Joe is committing fraud, keep going at it.

You found no evidence of fraud, or you did, and hit the brick wall. It is now that you have the investigator let himself be seen. Throw a little panic into Joe. You are sure Joe is guilty, and that you won't get anywhere with it in the system, so go for it. Scare Joe, and let him know he is being followed. The investigator won't say who hired him, the insurance company or you, so let Joe guess. But he will tell his friends and co-workers, that he was investigated and they couldn't find anything about him because he was just too smart. His bragging will scare the next ten people not to try fraud. Every one on comp will know this real soon, and you will see a reduction in long-term cases.