Benefit Claims Abuse &
Private Investigation Services

Benefit Claims Fraud & The Role of Private Investigation

June 23, 2022

Private Investigation for Suspected Benefit Claims Fraud

Benefit claims fraud across North America tends to increase as warmer weather arrives. Fraudulent claims can result in significant losses and, in some circumstances, put your business in jeopardy. Workplace investigations can address employee insurance fraud and ensure that the claims made by your workers are, in fact, true.

Without the right efforts to protect and fight against claims fraud, many employers are opening the door to extensive losses due to abuse of worker’s compensation, sick leave, and disability. Many third-party investigation companies can act in your best interest and get to the bottom of suspected insurance fraud within your business.

Statistics for Benefit Claims Fraud For Business Owners

Benefit Claims Fraud is discussed in an office setting in Seattle.

Looking back at 2018, before the pandemic began, the Association of Certified Fraud Examiners reported that corporations faced a loss of over 5% of their total annual revenues due to their employees indulging in fraud. Combining this with today’s issues of worker absenteeism and labor shortages creates a recipe for disaster, especially for small corporations, and must be addressed before it’s too late.

An investment into a proper workplace investigation service can pay dividends in the long run, helping to maintain your bottom line and ensure your workforce is rooted in honesty and integrity.

Private Investigation For Workplace Fraud

There are many types of employee fraud, but these are the most common that every business owner in North America should know about. Many instances of fraud can be addressed by a workplace investigation that gets to the bottom of an employer’s suspicion and ensures all employees are held accountable for their actions.

Workers’ Compensation Fraud

Workplace injuries often prompt an employee to make a claim for worker’s compensation, but it places the employer in a difficult situation. Should an employee exaggerate or fake their injury or sickness, it could cost a business hundreds of thousands in lost wages and productivity and increased compensation insurance premiums.

At times, the employee may be tempted to assert that their injury is preventing them from working for extended periods of time, defrauding both the employer and the insurance provider. Ultimately, it’s in the employer’s best interest to determine the true severity of the injury. Worker’s compensation fraud can be difficult to prove and often requires the services of a third party to investigate without any bias. Internal investigations conducted on behalf of the business may lead to conflicts of interest.

Health Insurance Fraud

Should an employee stretch the truth or provide inaccurate information in an effort to obtain health insurance benefits, the employer is likely to face the brunt of the consequences. This is most often experienced when a worker lies to their employer in regard to their marital status, stretching the truth so that their partner, family member, or friend can receive health insurance coverage.

Fraud ultimately pulls essential resources away from those rightfully entitled to them and can also lead to increased premiums.

Long-Term Disability Fraud

Long-term disability insurance plays an important role for those who suddenly become disabled and can no longer work. Some workers might be tempted to deceive their employer and fail to report an improvement in their condition.

Some bad actors may go to great lengths to make a false claim for these benefits, even falsifying medical records and exaggerating their disability. Proving a fraudulent long-term disability claim is highly complex and requires the skilled services of an investigator who can properly document fraud with evidence that can stand up to litigation.

Addressing Benefit Claims Fraud with Workplace Investigations by AFIMAC

Enlist AFIMAC, the global leader in workplace investigation services, capable of tracking the movements of your employees suspected of conducting fraud. Our reach extends far beyond photo and video documentation and includes a deep social media investigation that can catch fraudsters and protect your bottom line.

Contact AFIMAC directly and explore services that can spot and document corporate benefits fraud before it grows into greater issues. Fill out the form below and contact us directly to learn more.