Does the current claim seem highly unusual or suspicious?
If so, alert the insurance company's Special Investigations Unit (SIU).
The SIU fights fraud and minimize exposure on suspect claims. bt reviewing each new claim file for “red flags” and investigating those indicators.
The SIU assign investigators and litigation specialists to pursue potential instances of fraud and coordinate with claims examiners to track the claim and make sound referrals to appropriate law enforcement agencies.
Insurance company employees are trained in when to make referrals to the SIU.
Tools used by SIU range from analysis of prior claims, retrieval of medical records, and analysis of the actual physical capabilities of person’s claiming to suspicious injuries.
Source: http://www.bhhc.com/workers-compensation/claim-center/fighting-fraud.aspx