Workers' Comp Fraud — How Defense Firms Actually Catch It

The public picture of workers' comp fraud is the dramatic video clip — a claimant on permanent disability seen waterskiing, or roofing a house, or moving a refrigerator alone. Those cases happen. They are not most cases.

Most fraud is incremental. The claimant has a real injury but recovers faster than reported. Or has a real injury and works the symptom assessment to maintain benefits beyond the genuine impairment date. Or has a real injury and a side cash job they did not disclose. The defense investigator's job is to document the daily reality and let the medical record, the testimony, and the surveillance triangulate.

Surveillance is ordered by the claims adjuster or by defense counsel when red flags appear in a file: claimant lawyered up early, conflicting independent medical exam (IME) findings, history of prior claims, observed activity that contradicts reported restrictions, or simply a high-value claim that justifies due diligence.

Engagement is typically a 16–40 hour authorization in 4-hour minimum blocks. We deploy two-investigator teams in unmarked vehicles, run rolling positions on the residence, and follow the claimant through their normal day until something inconsistent surfaces — or until we can document that nothing inconsistent surfaces, which is also a valuable finding.

The single most useful surveillance product in workers' comp is the activities-of-daily-living (ADL) log. We document everything the claimant did, when, for how long, and the physical demand involved: lifted a child into a car seat, carried two bags of groceries from the trunk, drove for 90 minutes without break, bent at the waist 14 times in the garden, mowed the lawn for 45 minutes, etc.

Each observation is time-stamped, photographed or video-recorded, and described in factual terms. We do not characterize 'pain' or 'limitation' — that is for the medical experts. We describe motion. The medical expert reviewing the surveillance compares observed motion against reported restriction and renders the opinion.

A subset of workers' comp investigations is documenting that a claimant on disability is performing paid work somewhere. The pattern is familiar — the claimant leaves home each morning, drives to a job site, and engages in physical labor.

Documentation of unreported work requires not just video of the claimant on site, but documentation of the employer, the payments, and the recurrence. We typically follow that pattern with corporate records work on the employer, business-license checks, and asset tracing through public records to support the claim that the claimant is earning unreported income while on benefits.

Claimants post things they should not. Beach photos, gym photos, hunting trips, marathon finishes — all show up in fraud cases. We preserve and authenticate that content using forensic capture tools so it survives a hearsay or authenticity challenge.

But social media is supplement, not substitute. A still photo from a Facebook post does not establish frequency or duration of activity — only that it happened once. Live surveillance establishing the pattern is what wins the case.

We follow and observe from public vantage. We photograph and video activities in public places. We document the pattern of life. We do not enter private property. We do not pretext the claimant or their family. We do not stage or provoke activity. We do not take any action that would compromise the admissibility of the surveillance.

When a surveillance produces a contested package, the lead investigator testifies at the hearing — to the methodology, the equipment, the chain of custody, and the observations. Our team has testified at JCC (Judge of Compensation Claims) hearings throughout Florida.