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Details Matter. A Case Study.

An insurance company client came to us with a high value Workers’ Compensation fraud case. They had great instincts and the claims department was convinced this guy was working construction jobs while on Workers’ Compensation and fraudulently claiming he was not working.

The insurance company had spent over $50,000 on surveillance trying to prove the fraud with no luck. This guy was slippery and knew how to play the system, the toughest kind of fraudster to catch. Having us look at the case was a last-ditch attempt before settling the claim. Did I mention this claim pay out was $300,000 plus what they have paid the guy throughout the 12 years they had the claim? High value was an understatement. Not to mention the disgust of knowing someone is stealing money from their employer and the insurance company and being unable to stop it.

We took on the case and after reviewing the facts of the case and the history of the claim we began the arduous task of going through 12 years of surveillance reports ranging from 20 to 50 pages long. Hundreds and hundreds of pages of details to review.

After hours of review, I found an entry that looked something like this:

1:00 pm – 2:00 pm: Claimant drove his 2015 Blue Ford F150 on numerous errands. Stops included: Walgreens, Target, No Name Motel, Walmart, McDonalds, and the Post Office then returned home. Stops were all brief and not considered work locations.

I reread that section a few times and asked myself, why would a guy stop briefly at a mom-and-pop motel in the middle of the day? The stop didn’t seem long enough for the obvious reasons and at that point I knew we had found what we were looking for.

Another investigator and I went to the motel the next day and discretely interviewed the owner and come to find out our claimant had been doing construction and repair work for this motel for years totaling well over $40,000. The owner also told us he always paid by check and that he had referred our crooked claimant to numerous other small, mom and pop motels and provided the names.

After conducting our other interviews and compiling our report, we submitted our investigation results to the insurance company legal department and based on our work they had enough to subpoena the claimant’s bank statements, deposited checks, and full financial information and bring him before a Judge.

After a brief 8 month wait, the claimant was found to have committed Workers’ Compensation fraud and we had a client for life in that insurance company.

I love this story because not only was it a great feeling for us to bust a workers’ compensation fraudster and deliver great results for a client, but this was an excellent learning opportunity and we often use this story in training sessions.

Here’s why:

In this case, not only did we locate the critical detail that broke the case open, but I think about that detail being in the report for us to find. Although the previous Investigator did not realize what he had at the time, he included that detail in his report. What if he had just written “the claimant conducted errands” without the locations thinking the locations didn’t matter because they were just routine? That criminal claimant would have received a check for $300,000.

Details matter in investigations.



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