Investigation Case Studies

Real examples of WCPI investigations. See how we document activity, collect evidence, and build cases that inform claims strategy and litigation decisions.

Case 1 Hawaii - Resort-Based Activity

Claimant Vacationing While on Restrictions

Initial Claim Details (Redacted)

  • • Claimant reported: severe back injury, lifting restrictions, mobility impairment
  • • Medical records: diagnosed lumbar strain, 6-week treatment plan
  • • Claim trajectory: high indemnity reserve, ongoing TTD payments
  • • Red flag: claimant reported traveling to Hawaii for "medical recuperation"

WCPI Investigation

  • • Destination: Oahu, Hawaii (2-week stay)
  • • Field timeline: 5-day observation
  • • Investigation scope: Resort activity, mobility observation, recreation documentation

Key Findings

  • • Claimant observed participating in beach activities (swimming, snorkeling)
  • • Documented recreational activities inconsistent with reported restrictions
  • • Photographed claimant hiking terrain and managing stairs without visible limitation
  • • Observation summary: activity patterns inconsistent with reported injury severity
  • • Evidence collected: 47 timestamped photographs, activity timeline, field notes

Outcome & Impact

Client reviewed evidence with defense counsel. Investigation supported claim challenge. Result: Claimant agreed to reduced settlement and case closure. Estimated savings: $85,000 in avoided indemnity and continued TTD exposure.

Case 2 Mexico - Destination Travel

Claimant Travel During Active WC Claim

Initial Claim Details (Redacted)

  • • Claimant reported: work-related injury with restricted mobility
  • • Claim status: ongoing TTD benefits, pending vocational rehabilitation
  • • Red flag: intelligence indicated claimant traveling to Mexico for vacation
  • • Claims manager: concerned about activity level inconsistency

WCPI Investigation

  • • Destination: Cancun, Mexico (10-day resort stay)
  • • Field timeline: 4-day observation
  • • Investigation scope: Presence verification, activity observation, resort pattern documentation

Key Findings

  • • Claimant observed at resort daily, participating in all-inclusive activities
  • • Documented participation in water sports, excursions, nighttime entertainment
  • • Observed claimant displaying physical capability and mobility inconsistent with claim
  • • Evidence collected: 52 photographs, activity chronology, excursion documentation, field notes

Outcome & Impact

Evidence submitted to claims manager and defense counsel. Investigation informed negotiation strategy. Result: Accelerated case resolution with reduced settlement. TTD benefits adjusted. Estimated impact: $120,000+ in cost containment and accelerated closure.

Case 3 Hawaii - Surveillance & Documentation

Claimant Capability Documentation

Initial Claim Details (Redacted)

  • • Claimant reported: severe shoulder injury, no lifting capability
  • • Claim status: pending permanent disability rating appeal
  • • Issue: claimant reporting zero work capacity, but intelligence suggested otherwise
  • • Adjuster: concerned about accuracy of functional capacity assessment

WCPI Investigation

  • • Destination: Big Island, Hawaii (vacation stay)
  • • Field timeline: 6-day observation
  • • Investigation scope: Functional capability observation, activity documentation, physical demand assessment

Key Findings

  • • Claimant observed lifting, carrying, reaching in multiple contexts
  • • Documented claimant managing heavy items, hiking with weight, physical labor activities
  • • Observed physical capability and overhead reach inconsistent with claimed restrictions
  • • Evidence collected: 68 timestamped photographs, activity assessment, functional capacity analysis, detailed field observations

Outcome & Impact

Evidence used in permanent disability appeal. Documentation supported challenge to PD rating claim. Result: Claim appeal successful, PD award reduced. Attorney achieved favorable rating adjustment. Estimated savings: $95,000+ in permanent disability exposure.

What These Cases Show

WCPI investigations provide documented evidence that informs claims strategy at critical decision points:

  • • Settlement Strategy: Evidence supports negotiation positions and accelerates resolution
  • • Appeal Support: Documentation strengthens challenges to ratings, TTD, and indemnity claims
  • • Litigation Preparation: Organized evidence packages support attorney strategy and trial readiness
  • • Cost Containment: Early investigation prevents months or years of unnecessary exposure

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