Employer’s Tip Leads to a Criminal Investigation

Workers’ comp fraud investigations often start with an informative lead. It might be a tip that an individual is working while collecting disability or that a doctor is billing for more services than a typical day would allow.

In the case of a woodworker who filed three claims following his termination, the employer’s concerns over the validity of the claims piqued his curiosity enough to personally check to see what he was up to during working hours. The employer soon discovered that his former employee was working a new job in the same capacity he was working previously, just two months after he filed his claims. The employer reported this to ICW Group. Investigative surveillance was deployed using the informational leads he provided about where, when, and in what capacity he observed his former employee working.

Sure enough, surveillance observed the worker over multiple days at his new employer assembling cabinets, driving a forklift, carrying wood, and loading and unloading wooden cabinets. At this time, his doctor was also certifying his state disability and deemed him Temporarily and Totally Disabled.

At his deposition, he provided testimony directly in contrast to the surveillance video, testifying that he had not worked since leaving his previous woodworking job.

Because he lied under oath and state benefits were paid while he was working, ICW Group’s Special Investigations Unit referred the matter to local authorities, who opened a criminal investigation, which is still ongoing.

But for this vigilant employer, it may have never been discovered that the worker was employed and more physically capable than he was leading on to doctors.  Although justice for this worker remains in the balance, ICW Group will likely be able to mitigate settlement with this evidence.

Lindsey McLain
Lindsey McLain
Lindsey is a Supervisor in the Special Investigation Unit at ICW Group. Lindsey has investigated 100s of cases; many resulting in criminal charges filed by state prosecutors, and thousands of dollars in restitution paid to ICW Group. In addition to conducting fraud investigations, she also presents and produces anti-fraud training for ICW Group personnel, and hosts fraud prevention webinars that reach thousands of customers nationwide.

Related Articles

Commit Workers’ Compensation Insurance Fraud, and It Will Cost You

In early 2022 we told you about an upholsterer who was caught working another job under a different identity while earning disability benefits. ICW Group's Special Investigation Unit (SIU) launched...

Insurance Fraud Charge Leads to Restitution

In a 2021 Fraud Friday feature, we told you about a California man charged with eight felony counts of insurance fraud and attempted perjury after filing a workers' compensation claim for...

Top Three Reasons Employees Commit Workers’ Compensation Fraud

Creating the right work environment can help employers prevent workers’ compensation fraud. Over the years, workers have fallen prey to unlawful solicitors for unscrupulous providers who make false promises...

Sign up for the Work Comp Connect newsletter

Subscribe today and get work comp insights from ICW Group in your inbox.

Sign up for the newsletter