Surveillance Investigation: Catching a Workers Comp Fraud Red-Handed
net synergies realized above the initial target in the first year
Client Background
The owner of an Atascocita-based construction firm faced a daunting financial future: an employee had filed a claim for a herniated disc, backed by MRI results and a doctor’s order for total disability. However, several red flags emerged. The injury occurred shortly after the employee was passed over for a promotion, and a deleted social media post showed him active at a Kingwood barbecue. Despite these suspicions, the company was on the hook for years of disability payments and skyrocketing insurance premiums unless they could prove the fraud. They needed more than a “hunch”—they needed proof that would hold up in a court of law.
Challenge
Medical Legitimacy: The subject had a genuine MRI showing a disc issue, making it easy for him to “sell” the injury to doctors and insurance adjusters.
Calculated Deception: The subject was “claims-savvy,” using a cane and limping dramatically whenever he was in public areas or at medical appointments in Atascocita.
High Financial Stakes: The projected payout over the next few years exceeded $200,000 in medical and indemnity costs, not including legal fees and insurance premium hikes.
Detection Risk: The subject was vigilant. Following him required a discreet, multi-vehicle surveillance team to avoid “burning” the investigation.
Investigations
Our investigation moved through two distinct phases to build an airtight case:
Phase 1: Establishing Inconsistency. During the first week, we documented the subject’s public persona. He used a cane to walk into a doctor’s office but was filmed later that day at a grocery store carrying heavy bags with a full, normal range of motion.
Phase 2: Catching the Fraud Red-Handed. In the second week, we followed the subject from Atascocita to a residential job site in Pasadena. For four consecutive days, our surveillance investigation documented him working a side job as a roofer. We captured video of him:
Climbing 30-foot ladders over 25 times a day.
Carrying heavy bundles of shingles onto steep roofs.
Kneeling, bending, and using a pneumatic nail gun for 8+ hours straight.
The “Transformation” Log: We documented him limping into a Friday morning medical appointment with a cane, only to drive directly to the Pasadena job site 15 minutes later and begin strenuous manual labor without any physical aids.
Results
When the evidence was presented during a scheduled settlement meeting, the case was resolved immediately:
Claim Denied: The worker’s attorney dropped the case the moment the surveillance video was played. The $200,000+ liability was erased.
Restitution: The subject was ordered to repay $18,000 in previously collected benefits.
Criminal Prosecution: Based on our investigative report, the subject was charged with felony Workers’ Compensation Fraud in the state of Texas, resulting in 5 years of probation and a permanent criminal record.
Company Impact: The business prevented a massive increase in insurance premiums and sent a clear message to other employees that fraudulent claims would be professionally investigated and prosecuted.
The Bottom Line: A doctor’s note can be manipulated, but high-definition surveillance video does not lie. Our investigation saved an Atascocita business from a six-figure fraud scheme and ensured the “injured” worker was held accountable.
The Results
Customer orders remained steady during the sales transition, and financial performance in the impacted business units exceeded internal forecasts.
Sales representatives were shifted toward the future-state, guided by the new organization structure, territories, product coverage, and compensation design in both North America and Europe.
The combined company was also on track toward full integration of sales enablement tools, including revised training programs, rationalized sales IT systems and updated sales dashboards and performance metrics.
Identified net synergies for the third year expected to exceed expectations at 1.5 times the initial target.
Guide the Process and Solve Problems
A weekly, executive-level decision mechanism to guide the process and solve problems as they arise.
“We wouldn’t have gotten to where we are today without Finovate. The Finovate spent time with us to better understand our processes and where our bottlenecks were.”
