I have seen my share of many types of fraud during my career with the NYPD and as the owner and lead investigator of Gold Shield Investigations.
Workers Compensation Fraud has numerous distinct signatures which Private Investigators and Claims Adjusters should be familiar with. When I review a case I look for a few of the following to be present.
- The injury occurred with no witnesses present or the witness that was present is a close co-worker/friend to the claimant.
- If a witness was present during the alleged injury the witness statement conflicts with the claimants statement.
- The claimant uses many sick days, has a discipline problem and/or has been disgruntled.
- The claimant cannot recall specific details about the injury.
- The injury was reported at a later date.
- The claimant is a new employee.
- The accident report has changes, erasures etc.
- The accident occurred right before claimant’s retirement.
- The claimant is injured after receiving disciplinary action, demotion etc.
- The claimant’s injury occurred his/her first day back to work from day(s) off vacation etc. Especially if the claimant is active with sports activities, home repairs etc.
- The medical report and incident reports are conflicting.
- The claimant’s address cannot be confirmed and or he/she does not have a working phone number.
- The claimant is having personal problems such as divorce, financial problems, child custody etc.
- The claimant has had numerous jobs over a short period of time.
- Anonymous tips phoned in.
- The claimant’s life style does n’t coincide with his/her salary.
- The claimant is tanned, in above average shape etc.
- Members of the claimant’s family are on workers compensation or have had many lawsuits
Then comes surveillance which tells the whole truth and nothing but the truth.