When it comes to sniffing out fraud in a workers’ comp case, Vigilant’s claims managers are as tenacious as bulldogs. When they see a red flag, they sink their teeth in and don’t let go.
Take the recent case of a welder formerly employed by one of our Washington Workers’ Comp Retro Group members. After performance issues, poor attendance, and taking a fall—all within the first month of employment—the worker filed a claim and found a doctor who certified that he was unable to return to work and needed surgery. The manufacturer was looking at two years or more of time loss in addition to substantial medical costs.
20 Percent Off the Clock
After thoroughly reviewing the case, a Vigilant claims manager spotted the red flags. First, the incident happened soon after the employee was hired. Second, co-workers interviewed by Vigilant’s claims manager relayed how the employee had distributed flyers in the workplace before and after the accident, advertising his services as a tattoo artist and even offering a 20 percent discount!
A corroborated three-month investigation by Vigilant and L&I included a visit to the claimant’s tattoo parlor, where investigators filmed him bending, stooping, twisting, and using his arms without physical difficulty. One of the investigators even got a tattoo (Apparently, he was a pretty good tattoo artist!) Vigilant’s claims manager also insisted on an independent medical examination. After the IME and the attending physician reviewed the video footage, they found the worker to be medically stable and capable of working. The claimant now faces criminal charges of workers’ comp fraud for illicitly receiving time-loss payments. Vigilant’s tenacity saved the manufacturer approximately $150,000, saving more than two years of time loss and medical costs.
Act Fast, Investigate Early
Vigilant’s goal is to move claims toward closure as quickly as possible, but not without a thorough review. When one of our claims managers spots something fishy, we initiate an investigation as quickly as possible while the incident is still recent so co-workers can be interviewed before they forget or move on to another job. Our experience provides unique insights into the nature of not only the incident, but also the people involved. We also have a wealth of tools available to get to the truth, including social media investigation and surveillance. There are no rubberstamp approvals on any workers’ comp case at Vigilant.
When it comes to exposing fraud, it takes people who have seen it all to spot something you may have overlooked. Call Vigilant today and let us convince you.
This website presents general information in nontechnical language. This information is not legal advice. Before applying this information to a specific management decision, consult Vigilant or legal counsel.