How Private Investigators Investigate Workers’ Compensation Fraud

Workers’ compensation insurance exists to provide important financial and medical support to employees who are legitimately injured or become ill as a result of their employment. For employers and insurance companies, however, questionable claims can create significant financial and administrative challenges. When there are legitimate reasons to question whether an injury is being accurately represented, a professional investigation can help uncover facts that may otherwise be difficult to establish.

Workers’ compensation investigations aren’t simply about following someone around and hoping to catch them doing something suspicious. A professional investigation requires planning, observation, research, documentation, and careful attention to the facts. The goal is to determine whether the available evidence is consistent with the claims being made.

For example, an employee may report an injury that allegedly prevents them from performing certain physical activities. An investigator may be asked to determine whether the individual’s observed activities appear consistent with those reported limitations. In other situations, questions may arise about when or where an injury occurred, whether an individual is following medical restrictions, or whether information provided as part of a claim is accurate.

At Kinsey Investigations, workers’ compensation investigations can involve a combination of surveillance, online research, public-record research, interviews, and other investigative techniques. The specific approach depends on the circumstances of each case.

Understanding how these investigations work can help employers, insurers, attorneys, and other interested parties recognize what a professional investigator can contribute when a workers’ compensation claim raises legitimate questions.

Beginning With the Available Information

Before conducting fieldwork, an investigator needs to understand the circumstances surrounding the case. Information provided by a client can help establish the basic facts and identify questions that need to be answered.

This may include the nature of the reported injury, claimed restrictions, relevant dates, known addresses, vehicles, employment information, photographs, and other information connected to the claim.

The purpose isn’t to assume that a claimant is being dishonest. Instead, investigators use the available information to develop an investigative plan that can objectively address the questions presented.

Conducting Surveillance

Surveillance can be an important component of a workers’ compensation investigation.

Depending on the circumstances, investigators may observe a subject during activities outside the workplace. The investigator may document where the individual goes, what activities they perform, and other relevant observations.

For example, if a claimant reports restrictions involving lifting, walking, climbing, or other physical activities, investigators may document activities they observe that appear relevant to those restrictions.

An important distinction is that surveillance doesn’t automatically establish fraud. An isolated activity may not tell the entire story. Investigators document what they actually observe so that the information can be evaluated in the context of the claim and any applicable medical restrictions.

Online and Public-Record Research

Modern investigations can involve much more than physical surveillance.

Investigators may conduct research into publicly available information and online activity that could provide relevant leads. This type of research can help investigators identify activities, locations, relationships, or other information that may warrant additional investigation.

The key is connecting information to the actual questions presented by the case. Simply finding something about a claimant online doesn’t necessarily prove anything about a workers’ compensation claim.

Interviews and Information From Other Sources

In some investigations, speaking with people who may have relevant information can provide another avenue for establishing facts.

Investigators may conduct discreet interviews with individuals who are associated with a subject or who may have knowledge relevant to the investigation.

An interview may help confirm or clarify information obtained through other investigative methods. When appropriate, information from interviews can be compared with surveillance observations, records, and other evidence.

Documenting the Findings

One of the most important parts of an investigation is documenting what was actually discovered.

Investigators aren’t simply looking for information that supports a particular conclusion. They should document relevant observations and distinguish between what they directly observed and what they learned from other sources.

This can include photographs, video, written observations, research findings, interview information, dates, times, locations, and other case-related details.

Thorough documentation allows clients and, when appropriate, their attorneys or other professionals to evaluate the information in context.

Why Professional Investigations Matter

Workers’ compensation cases can involve complicated circumstances, and determining whether a claim is accurately represented may require more than reviewing paperwork.

A professional investigator can bring together different investigative methods to develop a clearer picture of the circumstances. Surveillance may provide direct observations. Research may identify useful leads. Interviews may provide additional information. Careful documentation can then bring those pieces together.

Kinsey Investigations provides workers’ compensation and insurance-fraud investigation services throughout Los Angeles and Southern California. Our firm is a licensed, bonded, and insured private investigation company with experience conducting investigations for businesses, insurance professionals, attorneys, and other clients.

Contact Kinsey Investigations Today

When a workers’ compensation claim raises legitimate questions, getting reliable information matters. Attempting to investigate the situation yourself can be difficult, time-consuming, and may not provide the documentation or investigative perspective needed to properly evaluate the circumstances.

Kinsey Investigations can help you determine whether a professional workers’ compensation investigation is appropriate for your situation. Our experienced investigators can evaluate the information available, discuss your concerns, and develop an investigative approach based on the circumstances of your case.

If you have questions about a workers’ compensation claim or believe an investigation may be necessary, contact Kinsey Investigations today for your free, confidential consultation. We serve clients throughout Los Angeles and Southern California and are ready to listen to your concerns, answer your questions, and discuss the appropriate next steps for your case.