Reasons to hire a private investigator for claims investigations

Posted by Vendor Assurance Technologies LLC on October 22, 2019

It’s an unfortunate reality, but fraud happens. When it comes to workers’ compensation fraud, it can happen on both sides—the employee and the employer.

People see an opportunity to get money by falsely claiming or exaggerating a workplace injury, and they take it. Or employers skirt the rules by underpaying claims, misclassifying employees, or not carrying workers’ compensation insurance at all.

We know that most workers’ compensation claims by employees aren’t fraud, but the ones that are can seriously hurt a business by increasing insurance premiums and making the process harder in the future for employees who have legitimate claims.

The National Insurance Crime Bureau estimates that workers’ compensation insurance fraud costs companies $30 billion annually. Other sources indicate that only one to two percent of workers’ compensation claims are fraudulent, but it’s still a significant cumulative effect on businesses in the U.S

A private investigator can use several approaches to help ensure claims are legitimate before the company pays the claim.

Investigators and Claimant Fraud

Conducting Surveillance

If a company is suspicious that an employee may be faking an on-the-job injury, a private investigator can conduct surveillance for a few days to monitor the employee’s activity level outside of work. If an employee claims they’re unable to walk without crutches and can’t work but is then seen taking out the trash at home, there’s a good chance they’re exaggerating the injury.

Looking for repeat patterns

Private investigators can also do a background check to see if the employee has previously filed workers’ compensation claims and check the outcome of those claims. Sometimes there’s a pattern where an employee has filed multiple claims over several years but none have been paid out in the end, which may indicate repeated attempts at fraud. That’s not to say that employee can’t have a legitimate injury, but it’s worth looking into their background a bit to see if further investigation is warranted.

Assessing the accident or injury

On-the-job injuries can range anywhere from a minor cut that needs medical attention to a fall or a car accident. A private investigator can help reconstruct the accident based on the employee’s statements and even interview witnesses if necessary to help assess what happened.

A private investigator, especially a local independent agency, can be an important asset in your claims investigations process. If you’re working with multiple private investigators and looking for an efficient way to manage those investigations, check out the VenAssure platform today.


VenAssure is not a private investigation agency. We’re a pure technology platform that allows companies and investigators to connect and manage all inbound and outbound communications. Find local investigation agencies, manage vendor assignments, and protect sensitive claimant data with VenAssure, the hub for insurance fraud investigations.