I Caught An Insurance Fraudster Red-Handed

Kathy in Claims manages dozens of new workers’ comp claims a month, many riddled with fraud. 

She’s been in the game so long, she can smell B.S. from a long way off. 

And even though this claim won’t amount to huge dollar savings for this client, fraud is a fraud, and it can’t be left alone.

Wouldn’t you report a stolen car if you saw it happen?

The Subject

Now, the Subject, Gary the Goldfish, is working what we call “light duty” where he isn’t working his full job, but a desk job. We call it a sedentary duty. 

But, if Kathy doesn’t act quickly, this Gary’s employer’s premiums will skyrocket, leaving them with huge and unnecessary medical bills to pay. 

So her goal is to get this Gary back to work ASAP.

And, that’s where we stepped in.

Now, Kathy knows we’re good at surveillance, but she hadn’t yet used any of our online intelligence and social media gathering services. 

And sure, staking out the guy’s house and tailing him around town capturing footage along the way would usually be beneficial. 

But this seems to be the odd case where even though he’s active, our team can’t seem to get that “smoking gun” footage. 

He drives from place to place, but never really gets out of his car, and he moves around in public with a little limp. 

So, after a few days of surveillance, we’re back to the drawing board. 

Whether he’s been coached up by his attorney or he’s just generally suspicious, we don’t exactly know.

And on top of that, the last thing we’d want is to have our investigator burned out there, or compromised. That could backfire on us all together and Kathy would get the brunt of that. 

No Bueno. Not good at all.

So, instead of draining the client’s budget with costly surveillance, we change our strategy and focus on what we can collect online and using social media.

Social Media and Online Intelligence

Our team, which had done some digging already, dives in deeper. 

We already knew Gary had a drug conviction years ago and some financial issues, but we find some juicy details.

It turns out our guy is selling drug-infused products, not illegal ones, but selling them on Facebook. More importantly, but it shows he’s got a business on Facebook, and maybe even one with a business license.

Not only does he have business cards, and a sales booth, but he posts videos online of the products with him as the featured spokesperson. 

It turns out he indeed does have a business license, we’ll call the company name, “Goldfish Enterprises” and he’s the registered agent and founder. 

Icing on the Fraud Cake

What’s more, he recently received almost $10,000 in Federal Paycheck Protection Program loans, and he claims he has three employees.

His Facebook profile also shows him featured on podcasts and YouTube videos where Gary discusses this company but hip-hop culture. Many of which were filmed on or around the date on which he was injured. 

So, with all this evidence showing that he’s active in real life and on social media, but that he has an active company with supposed employees, this case turns into a winner for Kathy. 

Saving our client money and getting Gary the Goldfish back to work was just one of the many positive results of using social media and online intelligence to defeat this claim. 

He defrauded the WC system, bilked his company out of his wages, and even defrauded the government (turns out he didn’t really have 3 employees after all).

Conclusion

The end result is that his claim was dismissed and his disability compensation was denied. Fraud prevented!!