Employers and insurers hire private eyes to probe sick-leave scams

Employers and insurance firms turning more to investigators to look into fraudulent claims for time off as premiums for cover mount

PUBLISHED : Thursday, 02 May, 2013, 12:00am
UPDATED : Thursday, 02 May, 2013, 7:25am

More companies are hiring investigators to check the authenticity of sick leave claims as insurance premiums have risen steeply in recent years.

And it's not just people taking the odd Monday off after a long weekend - employees are using more sophisticated techniques to cheat their bosses, sometimes for months at a time.

The managing director of investigation firm Verity Consulting, Kelvin Ko Chiu, said sick leave claims involving private companies and their insurers now accounted for more than 50 per cent of his cases, up from 20 per cent 10 years ago when he entered the profession.

He said companies were getting more conscious about sick leave claims as insurance premiums to cover staff had increased by 20 to 30 per cent over the past two or three years.

Ko said one of his surveillance cases involved a patient who claimed he was injured in a car accident, and wore a neck brace and carried a telescopic walking stick every time he visited hospital and the insurance office.

But his team kept tabs on the man and found that he removed the brace and bagged the stick when he was on his way home.

"Sick leave fraud mainly involves two issues," Ko said. "The first is whether the injuries or illnesses actually exist. The second is whether the seriousness of the complaint has been exaggerated."

A postal worker was jailed for 26 months recently for using counterfeit documents to bilk Hongkong Post of 635 rest days after he genuinely received three days off work for injuring his finger while performing his duties.

Ko said that in most fraudulent cases employees claimed they were suffering from lower back pain or had soft tissue injuries. Another extreme case involved a clerk who claimed he had sprained his back at work.

"For six months, he went to work for a few days, then called in sick for few days," he said. The clerk would produce authentic doctors' sick leave notices to his employer.

Ko's investigators followed the man and found that he spent time at a shop when he was taking sick leave. Ko said further surveillance led investigators to believe the man might have been working there.

The president of the Medical Association, Dr Tse Hung-hing, admitted that there would always be a small number of doctors who handed out sick leave notes to patients indiscriminately. But he said it was difficult for a doctor to verify symptoms like pain.

"If a patient claims that pain is his only symptom for a long period of time, after carrying out all possible medical examinations the doctor should refer him to another physician instead of granting him long sick leave," Tse said.

To prevent false claims, Ko advised companies to keep proper documentation on employees' injuries and sick leave. The companies could also arrange for their own doctors to check cases, he said.