Workers’ Comp or Workers’ Con? How to Protect Your Business from Fraudulent Claims

When it comes to workplace injury claims, diligence matters. While most employees who file workers’ compensation claims are genuinely hurt and deserving of support, employers occasionally face questionable or inconsistent reports that warrant further review.

At Paravel Risk Management, we specialize in helping companies navigate the complexities of these sensitive cases. Here’s how we recommend approaching potential fraud or exaggerated injury claims—professionally, lawfully, and thoroughly.

Step 1: Document Immediately and Thoroughly

Start with facts. Create a detailed record of the incident, including:

• Time, location, and witnesses

• Reported symptoms or injuries

• Environmental conditions

• Surveillance footage (if available)

A structured and timely incident report establishes the foundation for any future investigation.

Step 2: Review Medical Consistency

Compare medical reports against the nature of the job and the incident described. Red flags include:

• Delayed reporting of injuries

• Frequent vague or shifting symptoms

• Resistance to independent medical evaluation

Seek clarity, not confrontation.

Step 3: Conduct a Professional Interview

Engage the employee respectfully, asking consistent follow-up questions:

• Can they describe the moment of injury?

• What job tasks were they performing?

• Have they ever had similar symptoms or prior claims?

Focus on tone. The goal is fact-gathering, not accusation.

Step 4: Leverage Surveillance and OSINT

If appropriate, discreet surveillance or social media review may support the findings. Indicators of misrepresentation might include:

• Inconsistent activity levels compared to reported limitations

• Public posts that contradict medical restrictions

Paravel’s investigators use ethical, compliance-first methods to validate activity claims.

Step 5: Report, Evaluate, Act

Once evidence is gathered, we help clients:

• Compile findings into HR/Legal-ready formats

• Decide whether to escalate to insurers, legal counsel, or pursue corrective action

• Maintain appropriate records for compliance and future reference

Every case is different—and every step must be handled with integrity, impartiality, and compliance.

Ready to Protect Your Workplace Integrity?

Let Paravel RM guide your organization through sensitive workers’ comp concerns with professionalism, clarity, and compliance confidence.

Contact us today: Paravel Risk Management Phone: 605-759-8778 Email: info@paravelrm.com