Worker’s Compensation Investigation

WORKER COMPENSATION DEFENSE INVESTIGATION / SURVEILLANCE

Blue Systems International, private Investigators are trained in sub-Rosa surveillance techniques that are designed as the most powerful advanced defense against a worker compensation fraud investigation by an employee. Just imagine an employee or a claimant is complaining about how his back, neck and leg hurts and furthermore, he can’t walk or go to work. What would happen if a surveillance private investigator obtained video and photos of the same employee or claimant walking around, working a normal job and biking or hiking. How will the Judge at the court, think  and rule in this case?

Blue Systems International through experienced and knowledgeable private investigators, have developed the most advanced worker compensation investigation and defense system and tactics.

Why hire a private investigator for worker compensation defense investigation?

Catching employee or independent contractor filing a fraudulent worker compensation claim is our business and goal.

A worker compensation claim is considered as a can of worms on steroids that will exploit your personal and business finances; If not addressed within a timely manner. Avoidance and ignorance are the worst options in dealing with a worker compensation claim, since it will not go away or be dismissed. You can’t close down the company and open up another company and get away from the litigation and after math of a Worker compensation claim. If you don’t carry Worker’s compensation insurance at the time of an employee making a claim, than a claim to the state of California worker compensation fund will be valid. The state of California worker compensation fund will prosecute you personally and your company for not carrying worker compensation insurance. You can’t file bankruptcy and discharge a California worker compensation fund claim. If you have worker compensation Insurnace than a claim will cause your premiums to rise significantly. The best option is worker compensation defense investigation and surveillance. Once the worker compensation claim is investigated thoroughly, efficiently and all the evidence is collected within the guidelines of the law including the compliance of all legal procedures.You can save thousands of dollars by hiring a worker compensation defense investigator. Positive and accurate results with a Sub-ROSA Surveillance and thorough investigation may cause the Worker’s compensation claim can to be dismissed based on fraud. Most worker compensation attorneys enter into a contingency agreement with the clients. A fee professional attorneys fee agreement based on a percentage of winning the worker compensation case and collecting the judgment ordered by the court.

You must address and handle the worker compensation claim since you can’t change company name or file for bankruptcy to ignore it or avoid payment. The state of California will prosecute you for not carrying Worker’s Compensation.

Our private investigation firm is licensed, insured and bonded. MJ PI is the chief investigator with over 27 years of experience as a private investigator and litigation support legal investigator. The most reliable and powerful defense to a worker compensation case is surveillance by a qualified licensed private investigator. Obviously, once the private investigator has successfully completed the surveillance and is capable to prove that the claimant is committing fraud by making false accusations of being injured. Pictures are worth a thousand words and video surveillance are priceless. No attorney or a court of law can object to or dispute photo and video footage that was obtained legally, preserved and authenticated. As a matter of fact, the case most likely will be dismissed, once the claimaint’s attorney finds out the Blue systems International private investigators have conducted a successful surveillance and has collected the evidence to prove their client is committing fraud. It’s very common for worker compensation attorneys to dismiss the case and drop their client since the worker compensation attorney is working on contingency and it wouldn’t be worth it to defend a client who is dishonest and committing fraud.

CAN I RECOVER MY LEGAL COSTS FOR PRIVATE INVESTIGATORS?

You must prove that the claimant of the worker compensation has committed fraud and filed a bogus claim. Once a successfully surveillance has been completed and we are able to prove that the claimant claim intensions were fraudulent in nature than you can file a civil lawsuit against the employee/claimant in order to recover any damages, losses, legal cost or private investigations fees.

WHY SHOULD I HIRE AN EXPERIENCED WORKER COMPENSATION DEFENSE INVESTIGATIONS FIRM ?

You should always hire a private investigation that is licensed and insured.

Blue Systems International (BSI) is a team of former state and federal law enforcement investigators with combined experience of over 100 years. The private investigation agency is licensed, insured and bonded.

Blue Systems International private investigations firm has secured legal support from top notch worker compensation defense attorneys. Through BSI, experienced surveillance private investigators, ethics and work history we were able to connect with the top rated worker compensation defense lawyers.

One of the most important legal issues that must be address in a court of law, pertaining to worker compensation defense is the evidence. How the evidence was obtained, collected, filed, prepared, authenticated and entered into chain of custody in order to be entered in a court of law.

Many private investigators can conduct surveillance and watch a defendant; However, they may lack knowledge on court rules, regulations and litigation support. Blue Systems International private investigators are trained through a rigorous worker compensation investigation and defense legal. This course was set by an experienced worker compensation defense attorney who has extensive experience defending worker compensation claims for employers. The worker compensation investigation and defense system includes the legal knowledge, litigation support, the training and the ability to testify in a court of law under oath.

The workers’ compensation insurance in California, is a no-fault system. An employee filing a worker’s compensation claim is not required to prove that the injury was another person’s fault in order to receive workers’ compensation benefits in the state of California. All the employee is required to prove is that he or she was working on the job at the time of the incident and they were injured. The worker’s compensation relaxed legal system in California welcomes and entices scammers, con-artist and anyone to commit insurance fraud through filing a worker’s insurance claim. Of course medical bills and lost wages are covered by Worker’s compensation insurance or YOU. If you don’t worker’s compensation insurance; I urge you to hire a private investigator and start a workers’ compensation investigation soon as possible. If the state of California Workers’ Compensation Insurance fund covers the claim and pays out than they will subrogate through you, your company or assets. In other words you will be liable to pay back all the money to the State of California Workers’ Compensation Insurance fund. You will not be able to file for bankruptcy, there is now way out.

July 21, 2018 The claimant was observed eating dinner and drinking what appeared to be alcoholic drinks with two other couples.

At approximately 10:30 P.M; This investigator reports that the claimant drove her vehicle from the FireFly restaurant. Claimant exited the Parking lot and made a left, less than a mile and she abruptly changed lanes in front of a police cruiser. The police cruiser continued to follow the claimant who drove with extreme caution. The surveillance continued and the claimant drove onto Top Golf bar and sports center. Please see videos and photos as exhibits AR14 through AR731.

At approximately 10:40 P.M; This investigator witnessed and covertly video taped what appears to be the claimant having an aggressive argument with her boyfriend. At this time, claimant changed shoes, from high heels to a flat sandals; And walked approximately 200 meters, with boyfriend and the other couple who were at earlier dinner (FireFly), into Top Golf. The claimant along with her boyfriend and other couple, entered to the right area at door number one; Where it appears that her boyfriend was playing Golf. The claimant was observed standing for approximately 30 minutes on her feet. This investigator discreetly captured videos and without alarming claimant or anyone around since there was no place for investigator to stand and continually observe claimant. At approximately 11:10 P.M, the investigator lost track of the claimant. Please see videos and photos as exhibits AX271 through AX511.

At approximately 11:14 P.M, female investigator located the claimant along with her boyfriend and other couple who were sitting at the bar area and started drinking alcoholic drinks. At approximately 12:30 A.M, the claimant along with her boyfriend and other couple left Top Golf and started walking towards their parked vehicle which is approximately 200 meters; Both couples were extremely alert and looking around. Investigator had to change direction to avoid detection. Please see videos and photos as exhibits BT56 through BT911.



The claimant drover her vehicle and exited the parking lot from the North entrance and drove home. investigator drove straight to claimant house, where her car was parked in the driveway for confirmation. Please see videos and photos as exhibits DR122 through DR569.

THE MOST EFFECTIVE AND ONLY DEFENSE THAT YOU HAVE IS TO START A Workers’ Compensation investigation

1. A thorough background check investigation in order to uncover and explore any previous worker’s compensation claims or other fraudulent claims.
2. The background check investigation reveals all past address, employment and associates history.
3. Surveillance the claimant and video tape all activities; including driving habits.
4. Capture a video of the claimant while working, carrying items, exercising, jumping, running, swimming or any activity that contradicts the injury claim.
5. Store and seal the evidence through chain of custody and according to court procedures.

Our licensed private investigator are trained, experienced and understand the requirements in order to prove Worker’s compensation fraud. Combined Experience of over 30 years investigating fraudulent claims. 

Worker’s compensation investigations during 2012 to 2013, have led to a total of 815 arrests. The district attorneys has prosecuted 1,329 cases with 1,545 suspects, resulting in 721 convictions for worker’s compensation fraud.

In summary here are the statistics for Worker’s compensation fraud investigations During 2012 to 2013:

•  Arrests made in connection with Worker’s Compensation fraud investigations: 815
• The district attorney prosecuted cases with Worker’s Compensation fraud investigations  1,329 cases with 1,545 suspects
• The district attorney prosecuted convicted cases for Worker’s Compensation fraud: 721
• The district attorney prosecuted Restitution for Worker’s Compensation fraud investigations:
• The amount of $24,862,189 was ordered in connection with these convictions and $4,890,396 was collected during Fiscal Year 2012-13.
• The Total amount of worker’s compensation fraud that wasn’t collected through prosecution was $247,922,658. Actually this is not an accurate estimate since many worker’s compensation cases were not investigated or addressed correctly.

Fraudulent workers’ compensation claims is an easy money: sit home, watch TV, enjoy life and relax, for criminals. 

Private investigators are up early to catch a worker’s compensation claim faker.

Good news; The Workers’ Compensation Fraud Program was established in 1991. The legislature made workers’ compensation fraud a felony, required insurers to report suspected fraud, and established a mechanism for funding enforcement and prosecution activities. The legislation established the Fraud Assessment Commission to determine the level of assessments to fund investigation and prosecution of workers’ compensation insurance fraud.

Workers’ compensation insurance fraud occurs in simple and complex schemes that often require difficult and lengthy investigations. Most of the time, employees exaggerate or even fabricate injuries. Unfortunately, Insurance companies “pick up the tab,” passing the cost onto policyholders, taxpayers and the general public. 



Regrettably, we all pay out of pockets every day for the Worker’s compensation program through California employers who are legally required to be insured or self-insured. Workers’ Compensation Fraud has caused approximately an aggregate assessment for Fiscal Year 2012-13 of $53,445,000.

During Fiscal Year 2012-13, the Fraud Division identified and reported 5,151 suspected fraud cases; (SFCs) assigned 847 new cases, made 268 arrests and referred 309 cases to prosecuting authorities. Potential loss amounted to $212,710,721.

Workers’ Compensation Fraud Convictions information was found through the District Attorneys’ Workers’ Compensation Program.

Fraud Claims and Forms

Suspected Fraudulent Claims (SFCs)

The Fraud Division has established a method for insurers to report suspected insurance fraud. It is important to know that notification of insurance fraud may be made anonymously. You may contact any of the Fraud Division Regional Offices directly responsible for your county. Other types of complaints may be directed to the Department’s Consumer Services Division. For further information about the Fraud Division and its programs, visit the Fraud Division’s home page.

The Insurance Code states that no insurer, or the employees or agents of any insurer, shall be subject to civil liability for libel, slander or any other relevant cause of action by virtue of providing information concerning a Suspected Fraudulent Claim (SFC) to law enforcement, including the California Department of Insurance, Fraud Division.

There have been some minor upgrades to our intake process that will allow us to email the initial status letters to a referring Special Investigative Unit (SIU). The Fraud Division receives on average 27,000 referrals each year across all fraud programs. Until recently, the process required the Fraud Division to print and mail the initial status letters to the referring SIU. The letter will now be sent to the email address that is provided on the FD-1 or eFD1. If no email address is provided, the letter will be mailed.

• Suspected Fraudulent Claim Form (electronic eFD-1)
• Registration to Submit Electronic eFD-1s on a Continual Basis (i.e. Insurers, TPAs, Self-Insureds)
• Suspected Fraudulent Claim Form (electronic eFD-1)

http://www.insurance.ca.gov/0300-fraud/0100-fraud-division-overview/