Stop Workers' Comp fraud before it stops you.
Soaring Workers' Comp costs have reached new highs with no end in sight. Companies downsizing or ceasing regional operations are prime targets for fraud, pushing them even deeper into debt. A significant increase in the benefit schedule for injured employees will further impact the frequency of the number of fraudulent or exaggerated claims submitted by dishonest employees. California employers are expected to see triple digit increases in premium costs or reserves within the year. Now more then ever is the time to put a comprehensive fraud abatement program in place. Employers, insurance companies, and TPAs need to partner and create a culture of prevention, accountability and integrity within the work force. Partnering with Roberts & Associates will reduce claim costs by exposing fraudulent and malingering claims while legitimizing those that are accurately reported.

Roberts & Associates can provide tenured staff to conduct AOE/COE investigations including statement collection, photographs, and records research to determine compensability and potential subrogation early in the claim. When an suspicion of potential fraud exists, our surveillance team can determine the activity level of the claimant and capture video evidence of physical movement inconsistent with their alleged injuries. Pro-grade digital video equipment is used to document and archive evidence. Our investigators routinely testify at the Workers' Comp Appeals Board and Federal Courts. They are able to handle tough cross-examination and professionally interface with attorneys and physicians during trial or deposition.

Fraudulent Liability Claims also on the rise.
A record number of organized, staged, auto accidents and theft rings have been exposed in the last year giving concern to even greater levels of fraudulent claim activity then originally thought. Only by a thorough investigation of those claims that appear suspect can you make the proper decision to accept liability. A balance between service, equity and profits must be obtained to ensure the continued success of your firm. Call upon Roberts & Associates to provide the information you need to make the appropriate decisions and maintain that balance. Prompt service, attention to detail and a staff of experienced investigators will ensure that all of your investigative needs are met. From rush scene investigations, photographs and diagramming, to post accident surveillance on allegedly injured parties, Roberts & Associates is ready to be your partner.

What can I do?

AOE/COE interviews are a critical part of the claims process. In many cases, an outside investigator can be a cost effective way to obtain witness statements. Roberts & Associates' AOE/COE investigators are highly skilled at interviewing the appropriate people and obtaining detailed responses. Bilingual investigators are available to take statements from non-English speaking witnesses. Taped statements are then summarized and written reports delivered as the final work product

Sub rosa investigations are critical to evaluating the validity of a worker's compensation claim. Videotape, photograph or eyewitness testimony provides valuable evidence to support or impeach a claimant's testimony. Providing clear, steady videotape under difficult circumstances separates Roberts & Associates from other investigative agencies. It is not unusual for our investigators to procure videotape of claimants shopping in supermarkets, home improvement centers, auto supply stores and malls. In situations where videotaping is too risky, Roberts & Associates's investigators provide a detailed written account of their observations and are available to testify in court.

Roberts & Associates investigators typically spend 8-10 hours a day on a given sub rosa investigation. Investigators arrive early in the morning to determine if the claimant appears to be working at home or employed by a third party. If the claimant is inactive for an extended period of time, surveillance may be discontinued until the afternoon or another day. However, if the claimant is active, the investigator remains in observance until activity ceases or darkness prohibits further documentation.

Activity checks are a cost-effective way to determine if further investigative efforts are needed. These checks serve as a "snapshot" of a claimant's activity at a point in time on a given day. Our investigators arrive early and if the claimant is active, remain in observance until activity ceases. Video surveillance and other sub rosa techniques are employed as appropriate.

In addition, investigators perform a neighborhood canvas to attempt to verify the claimant's day-to-day activities and patterns including evidence of a home business, home improvement project or hobby that violates restricted behavior.

While an Activity Check may not result in concrete evidence of a claimant's fraudulent activities, it can provide a fairly accurate indication of the claimant's living environment and activity level. This information is communicated to the Claims Examiner to decide the future course of investigative action.