Typically, an insurance carrier would employ attorneys, private investigators and rehabilitation nurses. If vendors hired by insurance carriers attempt to commit fraud, examples of fraudulent activities by these groups would be when an attorney charges attorney rates for a secretary's time spent on a file, and when a private investigator charges for surveillance that was never really done. It's imperative for insurance carriers to closely monitor vendors work product and results. Fraudulent reporting by employers occurs because the rising cost of workers' compensation coverage has led some employers to try and lower their premiums through misrepresentation. Claimant fraud is by far the type of fraudulent activity I see the most of.
Exaggerated injuries are probably the most difficult to prove.
Typically, we would strive to have the claimant state what types of physical activities he or she is unable to engage in. Obviously, he was involved in very heavy work. We received a tip from the employer that this employee was involved with a band and played on weekends. We made some phone calls to find out where the band would be playing. The timing was great because, it was memorial day weekend.