Employer instructed workers compensation investigations are becoming more commonplace due to the apparent reluctance of some insurers to investigate suspicious claims.
The wording of the current legislation means that claims are usually supported and the employer is left with rising premiums and faced with holding the job position open while the claimant ‘recovers’.
If you have reason to believe an employee has made a false or exaggerated injury claim, our team of surveillance specialists can gather the evidence you will need to convince your insurer to reject the claim and freeze premium increases.
When to Investigate an Injury Claim
Discrepancies in the worker’s description of events.
The worker’s description of the incident conflicts with witness accounts, medical reports or the employee’s story changes slightly over time.
Possible Disgruntled Employee.
An incident immediately proceeds or succeeds significant changes to the worker’s employment conditions such as impending retrenchment, demotion or failure to secure a promotion.
Annual Leave issues.
The alleged injury is reported a few days before or after annual leave, or when leave has recently been refused.
Psychological Injury Claim.
Easy to feign and notoriously difficult to dispute, claims for psychological injury are a growing trend among fraudulent claimants. All claims of this type should be investigated.
The timing of a reported workplace injury is congruent with recent sporting activity or physically demanding hobbies.
The injured worker is known to have made previous claims.
Difficulty contacting the claimant.
The case manager repeatedly experiences difficulty contacting the injured worker directly.
Unstable work history.
The injured worker has a history of unreliability, has been performance managed or is known to have drug and alcohol abuse issues.
Problematic diagnosis and treatment.
When the injured worker seeks no ongoing treatment, obtains medical certificates from a practitioner outside their residential area or refuses to undergo diagnostic tests which will ascertain the extent of the injury.
When information is received from another source indicating that the claim is fraudulent. It is interesting to note that a large proportion of Centrelink Fraudsters are ‘dobbed in’ by close friends and family.