Workers Compensation Insurance Fraud

As Employment Goes Down……..

..then Fraud Goes

Jones Act Claims

More files than you can handle?

More files than you can handle?
We Can Help!!!

We can help You be more effective in
managing
your caseload!

Pre-Dated Coverage Losses

We know the “Dirty Doctors”
Subluxation!!!!

If Inflation Goes Up……..

..then Fraud Goes

AOE/COE Investigations

Alias Identification
If you’re not who you say you are, you don’t have a claim!

WA L&I Coordination

If Interest Rates go up……..

..then Fraud Goes

Fraud…… the “Iceberg “ Crime
87% of the
Iceberg is
Invisible
From the Surface

Some folks think Worker’sCompensation Claims are the

Scene Investigations & Photography

If Gas Prices go up……..

..then Fraud Goes

Premises Liability

Asset Investigations

Jones Act Claims

Asset Investigations

If the Dollar Goes Down……..

..then Fraud Goes

Witness Locates

Recognizing Fraud
One of the best indicators is your intuition.
“I just have a bad feeling about this claim…..”
“There’s probably nothing you can do , but can you take a look at this claim……”
“ I can’t put my finger on it, but there’s something that’s not right here…”

Recognizing Fraud
You don’t have to be a fish expert to know you’ve got a dead mackerel in your drawer…
If it doesn’t pass the “smell test,” There’s probably something fishy going on…

Litigation Histories

How do fraudsters think?
They all want
easy money.
and
They’re limited
only by their
imagination.

Public Records - Nationwide

Witness Locates
We routinely find them when other investigators have given up!

Public Records Nationwide

Background Checks

Fraudsters
talk to each
other!!

Neighborhood Canvasses

“Dirty” Doctors and Attorneys
Questionable claims tend to gravitate to questionable legal and medical professionals

Recorded Interviews

Witness Locates

Online Background Checks

Factual, In-Depth Reports

On Call 24/7

Criminal Histories may reveal:
Additional aliases
Relevant moral turpitude issues

Interviews of Represented Claimants

Pre-Existing Injuries?

File Reviews

Don’t Burn Money – Good Investigation is Cost Effective!

Questioned ProvidersHave Big Bills!

Are you Overworked?
We can Help!!

Medical Histories

Good Investigations Save Money!

Too many pending??
We can Help!!

Premises Liability

Partners in Fighting Fraud:
Seattle Insurance & Legal Investigations
Employers

Accident or Intentional??

As Housing Values Go Down……..

..then Fraud Goes

Employers
need to look
out for
Themselves!

A company’s reputation for resisting fraud is built over time!

Legitimate Claim or
Fraud?
When you need to know!

The most
effective
weapon in
recognizing
fraud is the
proactive Risk
Manager.

Liars are Thieves andThieves are Liars!

Financial Profiles

Insurance Claims = Easy Money!

When you get a reputation for
paying everyone that comes
to your door…….

When you get a reputation for
paying everyone that comes
to your door…….
You soon have a lot of people
coming to your door!

Workers Compensation Insurance Fraud

by JAMES CRONIN, CFE on Jul 28, 2009

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Workers Compensation Insurance Fraud — Presentation Transcript