Expert Insurance Fraud Prevention Services & Solutions

Fraud and exaggeration are stopped early, not after the fact. When an incident happens, you call us, not the insurer, and we evaluate it immediately. In many cases we send the injured worker to urgent care right away, which creates an accurate, timestamped medical record. That record is what protects you months later when a modest strain gets described as a career-ending injury. From there our risk managers monitor the file, pay legitimate injuries without a fight, and contest the exaggerated or staged ones. You can read more in our guide to preventing fraudulent workers' comp claims. Individual results vary.

We focus on workers' compensation exaggeration and fraud, which is where most employers quietly lose money. That means catching the gap between the 'lawyer number' and the real cost, an injury pitched as a $250,000 claim that carries maybe $30,000 in actual medical spend, then making sure it is paid on the real merits. We handle claims management, coordinate independent medical exams and surveillance when a file smells wrong, and lean on loss control so fewer questionable claims start in the first place. Genuine injuries still get paid, in full and without delay.

Yes, indirectly but significantly. Every exaggerated claim that gets contested or an inflated reserve that gets corrected keeps your loss history cleaner, and loss history drives your premium. Here is the part the insurance company won't tell you: once your premium rises after a bad claim, it rarely comes back down, even after the claim resolves. That makes it a multi-year cost. Controlling the claim now protects renewals for years. For qualifying businesses we also review classifications, high-deductible structures, and loss ratios to find further savings. See does workers' comp go up after a claim.

With an in-house team of experienced risk and claims managers, supported by customized software. Because the injured worker and the employer call us directly for the life of the policy, we see the claim in real time instead of reading about it weeks later in a carrier report. We document day one, track the medical course, order independent medical exams or investigation when the story shifts, and dispute the file where the evidence supports it. Left alone, an insurer tends to pay a claim at or near face value and call it a win. We don't.

Employers in high-injury fields with real premium at stake, think nursing homes, home health agencies, and hospitals, benefit the most. Our sweet spot is 100-plus employees and $100,000 or more in annual workers' comp spend, where a single exaggerated claim can move a renewal. Multi-location owners gain too; several nursing homes under one owner can often be consolidated into a single master policy for better terms. Home-care operators such as CDPAP agencies are a classic example, paying substantial premiums against relatively modest genuine claim activity.

No. Coverage stays intact, and policies are still issued by A+ rated carriers such as Travelers. What changes is how the claims underneath the policy are handled. We correct inflated reserves, move injured workers back to light-duty roles quickly, and contest exaggeration, so the loss numbers that set your premium reflect reality. For qualifying businesses, a high-deductible program can take on a defined first layer of risk and roughly halve annual premium while the same strong carrier sits behind it. Not every business qualifies, and we'll tell you honestly if yours doesn't.

Cash-flow improvement can show up immediately. Under a high-deductible structure your premium dollars stay in your account instead of being paid upfront, and claim payments are made incrementally, often around $1,500 to $3,000 a month, rather than as a lump sum, and they stop when the condition resolves. A worker who returns to modified duty in weeks instead of sitting out for months cuts the real cost of that claim sharply. Premium savings on renewals build over the following policy years as your loss history improves. Individual results vary.

We handle your claim directly and we're not incentivized by claim volume, because we're paid by commission from the insurer, not from your claim payouts. Large carriers default to paying claims at face value; it's simpler for them. We do the opposite: pay the legitimate ones fast, investigate and contest the exaggerated ones, and push return-to-work so an injured nurse becomes a receptionist-type role for a few weeks rather than a long-term loss. To review your situation we ask for your current workers' comp policy and five-year loss runs, then show you exactly where money is leaking.