Worker Advocacy and Preventing Workers’ Comp Fraud Aren’t Incompatible. Here’s How They Can Work Together
In a RIMS Live 2021 session, two leaders explained how they investigate workers' comp claims with integrity and pounce when finding fraud.
Topics: RIMS | WC Cost Containment | Workers' Comp | Workers' Comp Forum
Clad in a blue singlet, a professional wrestler jumped from the top rope and made a thunderous dropkick to his opponent’s chest. In a flash, he pinned his opponent and was declared victorious.
Not bad for someone receiving workers’ compensation benefits for back and wrist injuries.
Kevin Lederer, senior key account manager at Command Investigations, shared video of the match during a session of the RIMS Live 2021 conference.
In that instance, Lederer was investigating an injury claim made by a theme park worker. He learned that the claimant moonlighted as a professional wrestler. So on fight night, he took video and got clear-cut evidence of workers’ compensation fraud.
Later in the presentation, Lederer showed side-by-side videos.
One showed a worker explaining his mobility limitations due to arm and shoulder pain. The other showed him playing running back on an amateur tackle football team — getting tackled, blocking and even throwing a pass with his supposedly injured arm. Yet again, Lederer found fraud.
Lederer isn’t out to get anybody. He’s just doing his job.
“Finding a claimant and showing video documentation of their injuries being legitimate is just as important and impactful as getting someone jumping off the ropes at a wrestling match,” Lederer said.
His co-presenter, Steve Figliuolo, principal program lead at Chick-fil-A, agreed. He argued that employers should be advocates for injured workers while investigating claims. In fact, Figliuolo shared Chick-fil-A’s motto on the subject: “Pay the claims we owe and defend the claims we do not.”
“We believe the best claim is the claim that never exists,” said Figliuolo. “We like to dive in and focus on the root cause of an injury.”
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