Fraud in workers’ compensation is more common than most people realize. From false injury claims to shady staffing agencies, billions are stolen every year. That money doesn’t just vanish—it raises costs for self-insured employers, small businesses, and honest workers. To fight back, insurers and regulators rely on Special Investigative Units (SIUs).

These teams use everything from fraud detection software to video evidence collected by a surveillance firm. Their mission? To make sure the workers comp system stays honest and fair.

What Is a Special Investigative Unit?

A Special Investigation Unit is a team inside an insurance company that looks for red flags in claims. Their job is to stop insurance fraud before it drains the system.

SIUs use many different tools:

• Claims investigation with claims examiners and IME doctors (Independent Medical Examinations).

• Scene inspection at workplaces to verify what really happened.

• Background search and link analysis to spot suspicious connections.

• Social network data mining and social media checks to see if someone with “medical restrictions” is actually posting vacation photos of rock climbing.

Some even rely on micro video recorders and high video quality surveillance to catch a restriction violation in action.

How SIUs Run Undercover Operations

In many cases, SIUs work like detectives. They coordinate with organizations such as the National Insurance Crime Bureau and the Coalition Against Insurance Fraud. These partnerships give them access to business intelligence, predictive analytics, and cutting-edge risk control methods.

Sometimes they conduct undercover insurance operations. This could mean hiring a surveillance firm to follow someone suspected of faking a medical disability, or checking whether a medical provider is inflating bills. In Ohio, the Ohio Bureau of Workers’ Compensation has even become famous for creative public awareness campaigns—including TV spots with comedian Jeff Foxworthy filmed near Alum Creek—to remind people that fraud doesn’t pay.

The Role of Evidence Gathering

Good fraud cases rely on solid proof. SIUs focus on evidence gathering that holds up in front of a hearing officer or even in court. That might include:

• Video evidence of someone violating “medical restrictions.”

• Reports from an IME doctor showing no real injury.

• Scene inspection results that don’t match the worker’s story.

Every detail matters, from the clarity of the footage to the accuracy of background searches. That’s why video quality and proper documentation are so critical.

Why It Matters for Businesses

For honest businesses, the cost of fraud shows up in higher disability compensation payouts and skyrocketing premiums. If a staffing agency or employee cheats the system, the client company may still face liability. That’s where tools like the CheckMyCert.org complaint portal become important. Employers can report suspicious agencies and upload questionable COIs, adding another layer of protection alongside SIU investigations.

By combining fraud investigations in California with employer-led vigilance, the fight against workers’ comp fraud becomes stronger.

How Special Investigative Units Fight Insurance Fraud

So, how special investigation units fight insurance fraud comes down to teamwork and persistence. They use advanced predictive analytics, partner with watchdog groups like the Coalition Against Insurance Fraud, and lean on everyday people who file tips. From blog posts raising awareness to social network data mining, every effort chips away at fraud schemes that steal from workers and businesses.

Fraud in workers comp may never fully disappear, but Special Investigative Units make it harder for criminals to cheat the system. Whether it’s a fake injury caught on video evidence, a dishonest medical provider, or a shady agency exposed through the CheckMyCert.org complaint portal, the goal is the same: protect honest workers and businesses.

If you suspect fraud, don’t wait. Report it. Verify it. Keep the system honest.