Disabled or dishonest...L&W Investigations offers a PI's advice on spotting fraudulent workers' comp claims

May 06, 2008 // Franchising.com // WESTBOROUGH, MASSACHUSETTS- There's a common misperception that people who file worker's comp claims are "faking." According to L&W Investigations, a private investigations franchise specializing in insurance fraud, roughly 80 percent of all claims filed are legit, from people genuinely hurt and entitled to a worker's compensation claim.

"That's not to say companies should rubber-stamp every claim, but you shouldn't have a chip on your shoulder that everybody who files is trying to take advantage of the system," said Neal Lyons, CEO and chairman of L&W Investigations, Inc. "There are, however, a number of red flags that can exist in a potentially fraudulent claim and companies should be aware of these tendencies so you can nip the abuse in the bud."

Some of the more common red flags in cases of fraudulent workers comp claims include:

  • Multiple claims – has the claimant filed more than one worker's comp claim in the past or a number of claims within a short period of time?
  • Longer absences than anticipated for minor injuries; an unwillingness to come back to work on partial duty or other jobs within the company.
  • The claimant was experiencing financial difficulties and/or domestic problems prior to submission of claim.
  • The alleged injury occurs prior to or just after a strike, layoff, plant closure, job termination, completion of temporary work or notice of employer relocation.
  • Lawyer's letter of representation or letter from medical clinic is first notice of claim.
  • The claimant reports an alleged injury immediately following disciplinary action, notice of probation, demotion or being passed over for promotion.
  • There are no witnesses to the accident, or witnesses to the accident conflict with the claimant's version or with one another.
  • The accident or type of injury is unusual for the claimant's line of work.
  • The claimant frequently changes physician or does so after being released to return to work.



While identifying these red flags can help companies sniff out a lot of potential fraudulent claims, reports from fellow employees—anonymous and otherwise—unveil just as many. In fact, many larger companies offer toll-free number for employees to report suspected fraudulent claims.

"Insurance fraud and the expenses associated with it total more than $8 billion per year. That's not only paying fraudulent claims that go undetected but how much it costs to catch the abusers. A lot of times, that's after weeks, months or even years of abuse. By knowing what to look for and detecting it early, companies can reduce that figure dramatically," said Lyons.

L&W Investigations works with a variety of organizations-- insurance companies, third-party administrators, self-insured companies, law firms and municipalities—on fraudulent workers compensation, disability, liability, auto and property claims. L&W's offerings include: surveillance; statements; activity/disability checks; asset/background investigations; and medical audits/clinic inspections.

With 35 locations nationwide in 23 states, the L&W typically employs three to eight investigators at each office. While many traditional "mom and pop" investigative firms are typically a haven for retired law enforcement officers who treat the job more like a hobby, L&W employs seasoned investigators who specialize in investigating insurance fraud cases. All L&W investigators go through extensive training and have access to the most state-of-the-art surveillance equipment.

For more information on L&W Investigations, Inc, you can call their corporate offices at (508) 616-9370 or visit the Web site at www.lwinvestigations.com.

Not your everyday investigations firm

With 35 offices in 23 states, L&W Investigations, Inc. specializes in fraudulent insurance claims. In addition to nationwide coverage, L&W investigators are highly trained specialists equipped with state-of-the-art surveillance technologies and other advanced systems to provide second-to-none results and service. That includes online case status reports, video delivery by digital download or CD, DVD or VHS tape, rush services at no extra charge and much more.

Current offices are located in Arizona (Phoenix); California (Los Angeles, Riverside, Ventura) Colorado (Boulder); Florida (Miami, Ocala, Orlando, Tampa); Georgia (Atlanta); Hawaii (Honolulu); Idaho (Boise); Illinois (Chicago); Kentucky (Louisville); Maine (Portland); Massachusetts (Boston); Minnesota (Minneapolis); Missouri (St. Louis); Montana, (Missoula); New Hampshire (Nashua); New Jersey (New Brunswick); New Mexico (Albuquerque); New York, (Long Island); North Carolina (Charlotte, Raleigh); Oregon (Portland); Pennsylvania (Philadelphia); Rhode Island (Providence); South Carolina (Charleston); Tennessee (Nashville, Memphis); Texas (Houston, San Antonio, Dallas); Utah (St. Lake City); Vermont (Burlington); Virginia (Arlington); Washington (Seattle, Spokane); Wisconsin (Madison; as well as Puerto Rico (San Juan) and the Caribbean islands; and Canada (Toronto).

Franchise locations are still available and the company has set a manageable growth plan at 15 new units per year.

For additional information, visit the Web site at www.lwinvestigations.com or contact L&W's corporate headquarters located in Westborough, Massachusetts, at (508) 616-9370.

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