Scams and fraud come in many different forms and can shake the business world to small, medium and large-sized companies. Although, one of the most expensive is, without a doubt, work-related injury fraud which is also known as false workers compensation claims. This type of fraud costs millions of dollars to businesses and, especially, to insurance companies across the country every year.
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The call came from an entrepreneur who had been referred to my agency. “Detective, two months ago an employee of mine Gonzalo [name have been changed], stopped attending work, when we called him said that he had injured while working the week before and that his doctor had sent him to rest. Few days later we received a notification that Gonzalo had filed a worker’s compensation insurance claims stating that he had fallen during work at my company and that his back and shoulder pain did not allow him to have a normal life anymore. The security cameras of the company did not observe the fall either, although it is true that they do not cover the entire perimeter. All our employees have compensation insurance for cases like this, so it is the insurance company who will cover the expenses for his medical recovery but we were informed that the insurance will subsequently raise our premiums. We believe Gonzalo is lying about his accident and his medical condition. If it is a fraud we want to get enough evidence to unmask it. Can you help us?”
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“Of course,” I replied, “if it’s fraud, we’re going to find out.” We started the investigation watching Gonzalo at his house, but no activity was observed in the first two days of surveillance. We proceeded to establish the simultaneous surveillance in his house and in the medical clinic where he was attending because we obtained information about a scheduled appointment with his doctor. Gonzalo entered the clinic shortly before 11:00 am but he was never observed leaving his house, which showed that Gonzalo was lying about his residence. As he left the clinic, Gonzalo walked slowly and with difficulty, he advanced a block, entered his vehicle and then departed, not before making several laps in a circle to be sure no one would follow him, but we are already prepared to handle these tricks. We followed him for almost two hours to a residence in a small town; hours later we confirmed that this was the real residence of Gonzalo’s. The next day, we watched Gonzalo washing his vehicle, which included crouching, bending his knees, bending his back, and moving his shoulders a lot, quite the opposite of what a person should do with the supposed pains that he said he was suffering. Of course, everything was recorded in high definition video. Maybe this evidence was enough, but a good hunter must have patience and we do not lack any. About 6:00pm, Gonzalo came out of his house in sportswear, first walking, then began to run as a good athlete would and minutes later, he arrived at a second residence, his friend’s house, and in the courtyard of the same home, both were observed lifting dumbbells. Everything was recorded in detail, to the point that the video clearly showed the maximum of 270 pounds that Gonzalo raised in one of his many physical exercises. Bingo! Now we were ready to proof Gonzalo’s fraudulent claim.
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Once we completed the reports, videos and photographs, they were delivered to the client, who was very happy. The client met with the workers’ compensation insurance representative and handed him the results of our investigation, which proved in irrefutable evidence of the lies Gonzalo faked in his fraudulent claim. A few weeks later, during a meeting with the insurance lawyers and Gonzalo’s lawyers, the evidence was presented and in the light of it all, Gonzalo had no choice but to withdraw his claim and disappeared with his tail between his legs, so to speak. Our investigation had saved the insurance company more than $50,000 and hundreds of dollars from our client in an imminent rise of the insurance premium.
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Whether or not you have compensation insurance for your employees, it is always a good idea to investigate these claims. While many are justified claims, there are people who get involved with clinics and lawyers of dubious reputations to defraud insurance companies and businesses. This type of fraud affects us all because the greater the number of frauds, the greater the premiums of our insurance. For the well being of you and your company, always investigate these claims.
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Beware of fraud, but if you need help, call us at 866-224-1245.
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October 16th, 2016
By Private Detective Fernando Alvarez
DIARIO LAS AMERICAS
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