Each year, employers pay out millions in workers’ compensation claims, a portion of which goes to fraudulent claims. Workers’ compensation is intended to support employees who genuinely suffer injuries or illnesses resulting from their job, impairing their ability to work. However, fraudulent practices undermine the system, costing businesses and insurance providers significant losses.

Definition of Occupational Injuries and Diseases

As defined by the Occupational Safety and Health Act (OSHA), occupational injuries and illnesses refer to conditions caused by factors such as workplace structures, machinery, equipment, materials, chemicals, or job-related activities. This includes injuries sustained while performing job duties, work-related illnesses, commuting accidents, and fatalities.

Simply put, any injury, disease, disability, or death arising from work-related activities falls under the category of occupational accidents or illnesses.

Exaggerating Injuries to Inflate Claims

Fraudsters often maximize compensation by presenting exaggerated injuries. A common tactic involves seeking assistance from “claim consultants” or insurance intermediaries, who exploit information asymmetry or claim to have “special connections” to inflate settlement amounts. These intermediaries operate on a contingency fee basis, taking a percentage of the compensation as their profit.

Victims of this scheme may be coached to fabricate symptoms when consulting medical professionals, leading to misdiagnoses and inflated injury reports. These false claims are then supported by fabricated medical evidence, such as exaggerated doctor’s notes.

Courtroom Dramatics: Feigning Severe Injury

In court, fraudulent claimants often portray themselves as frail and incapacitated, only to return to their normal activities immediately after leaving the courthouse.

At Lex Solution Investigations, we collaborate with legal professionals specializing in workers’ compensation disputes. We understand the importance of providing irrefutable evidence, such as photos, videos, and audio recordings, which are admissible in court and critical in disproving fraudulent claims.

Uncovering Fraud Through Surveillance

The key to defeating workers’ compensation fraud lies in effective surveillance and obtaining solid evidence that exposes false claims of injury or restricted mobility. A single credible image or video clip can be more compelling than pages of written testimony. High-definition video footage can vividly demonstrate whether a claimant is exaggerating their injuries.

Lex Solution Investigations’ team of experienced investigators specializes in handling such cases. Our covert surveillance captures accurate, timely, and impartial evidence, including photographs, videos, and detailed reports. These materials are invaluable in determining whether an employee has engaged in fraudulent activity.

Our surveillance operations ensure claimants are adhering to their doctor’s recommendations and the diagnoses provided. By verifying these facts, we can confirm whether the claimant genuinely qualifies for workers’ compensation benefits.

Workers’ Compensation Defined

Workers’ compensation is a form of insurance that provides wage replacement and medical benefits to employees injured on the job, in exchange for waiving their right to sue the employer for negligence. This “compensation bargain” balances guaranteed, limited coverage with the lack of recourse outside the workers’ compensation system, addressing issues such as employer insolvency due to high payouts.

At Lex Solution Investigations, we are committed to ensuring fairness in workers’ compensation claims. By exposing fraud, we help protect businesses from unnecessary financial losses while maintaining the integrity of the system.