Workers Comp Claims & Fraud

Insurance Defense

When an employee is injured on the job site, he or she may have a legitimate claim for workers comp. It’s good and right for companies to pay out these claims, though doing so can incur some costs and/or some increases to insurance rates. These claims become problematic when they are filed fraudulently, by workers trying to game the system. Paying out on fraudulent claimscan be immensely wasteful, so it’s in the employer’s best interest to investigate each claim to ensure that it is valid.

NBI is proud to offer workers comp investigation services, wherein we help employers evaluate the available data and make fair and equitable decisions regarding potential claims. We can help employers avoid paying out on invalid claims, potentially saving them thousands of dollars in the process. Additionally, our services provide employers with the peace of mind that their workers comp system is not being exploited or taken advantage of unjustly.

If you have concerns about the validity of a particular workers comp claim, or simply want to put due diligence processes in place to protect your business, we invite you to contact the investigative team at NBI at your next convenience.

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AOE/COE Investigations

Workers comp investigations are sometimes abbreviated as AOE (Arising Out of Employment) or COE (Course of Employment) investigations—basically, efforts to ensure that the alleged injury actually happened on the job site, as part of the employee’s workplace duties.

That’s a big part of the service we provide at NBI. In handling any AOE/COE claim, we evaluate all the potential factors involved in the injury, and we always tailor our investigation to meet the client’s needs. This might mean simply assessing the claimant’s statement, or it might mean collecting testimonies from supervisors, co-workers, or other witnesses to the alleged accident. We may also collect signed medical releases as needed.

Our investigators understand that timing is key. We know that employers have limited windows in which to make decisions regarding these claims, and our team will always complete the investigation and file a full report, including key attachments, within 30 days.

National Business Investigations (NBI) uses a cloud-based case management system.  All clients are given access and are asked to create a unique User ID and Password - NBI's secure online case tracking system allows you access to your internal investigation data such as reports, statements, activity, billing information, photographs and video, right from your office computer.

 

We know that, in order to satisfy the needs of your insurance policy, precise and detailed reporting is required—and our investigators are truly robust in the information they deliver. The reports we provide always include a full spectrum of information, such as:

• Claimant information
• Occupation and duties
• Notice of alleged injuries
• Coverage
• Concurrent employment
• Information about the claimant’s lawyer
• Statements from supervisors and witnesses
• Photographs
• Claimant statement
• Date/location of alleged incident
• Medical history and treatment
• Benefits applied for or received
• Our final recommendations regarding the case

All of this information is uploaded to a secure, cloud-based server, allowing the client to quickly and easily log in to view updates on any outstanding investigations.

 

SUBROSA

Approached as a multi-step process, we gather intelligence on the claimant by equating their age, family dynamics, profession and employment history, and studying the general layout of the claimant's neighborhood and surrounding area. Although it is a welcomed element, Subrosa is not about being lucky. It is about knowing your subject and having a plan of action. In gathering video evidence, we remain mindful of the thrust of our investigation and identify and obtain whatever evidence is available to be used in adjudication. NBI has a reputation for excellence in the acquisition of video in both content and quality. Claimant video will be provided to you in standard VHS, Compact Disc or DVD format based on your preference.

 

Workers Comp Investigations from NBI

The investigation of workers comp claims requires thoroughness, speed, and precision—all of which makes it beneficial to hire trained professionals.

NBI is a leading private investigation company with decades of experience handling workers comp cases. Our investigators receive a higher standard of training than anyone else in the industry, and for that reason we’ve become the trusted investigative partner for companies in California and across the country.

No matter how specific your workers comp investigation needs happen to be, our team is ready to provide you with customized solutions. Learn more about the benefits in hiring an industry-leading workers comp investigation service—and put workers comp fraud behind you. Reach out to NBI today.

 

Workers Comp Fraud | AOE/COE | Subrosa | Private Investigations

Insurance Defense | Insurance Adjuster | Self Insured