A Maryland Delivery Driver who claimed to be injured while working was scheduled to attend an independent medical exam to determine either suspension or continuation of workers’ compensation benefits and disability status. Unfortunately, he missed the appointment and told his ICW Group claims examiner he had to accompany his wife to her medical appointment on the same day in an attempt to garner sympathy. He even provided a photo to prove his whereabouts. The explanation would have worked, and the claims examiner would have been sympathetic. However, the eagle-eyed claims examiner noticed the image was fabricated and suspended his benefits. The claims examiner worked with ICW Group’s Special Investigations Unit (SIU) to build a case and refer the matter to the Maryland Department of Insurance for a criminal case review.
Our SIU fraud-fighting team wants to remind anyone who thinks they can get away with a scam that it’s a crime to make a material misrepresentation of facts during the process of a workers’ compensation claim. Always tell the truth from the first moment an injury is reported and throughout the entire claims process. ICW Group has resources available to help educate your staff about fraud.