A 63-year-old truck driver filed a workers’ compensation claim alleging hip and wrist injuries after he fell into a pothole while trying to open a gate on his employer’s property. The incident occurred on a rainy morning and was caught on the employer’s surveillance camera.
Thanks to the collaborative and proactive efforts of the ICW Group Claims Examiner and Special Investigations Unit (SIU), statements were taken from the employer, who also provided the video footage. The video observed the man exit his truck and attempt to open the gate. At no time, however, was he seen falling, slipping, or appearing to injure himself.
Additionally, in statements to doctors, he denied any prior injuries to the claimed body parts. Contrary to what he said, medical records and new imaging revealed a history of issues in these areas, which he later admitted. Although doctors did not conclude if his alleged injuries were new or aggravated, it furthered the suspicion of his motive to make a false claim.
Following the investigation, ICW Group’s SIU presented the case to the District Attorney, who charged the man with four counts of insurance fraud, including the filing of a false claim and making false statements. He remains innocent until proven guilty.
Caught on Tape
Surveillance cameras in or around a business not only serve as a deterrent for crime but can be helpful to a workers’ compensation claim investigation. Video surveillance can help validate a legitimate injury or refute a false injury claim. Employees who know that their actions might be caught on film may be less likely to stage an accident.
This and other tips to prevent fraudulent claims in the workplace can be found on the ICW Group policyholder website. There you have access to informative webinars and various fraud materials that can aid in detecting and mitigating fraud in the workplace.
