Example Of Site Visit Report

In the recent past, California has emerged as one of the state in the US with many reported cases of fraud in workers’ compensation schemes. In actual sense, a quarter of all compensations extended to workers by insurers in California are false. The major types of frauds include internal, claimant and provider fraud, with the most rampant being claimant fraud. In order to minimize losses caused by falsified claims, relevant state stakeholders have structured policies meant to detect and punish compensation fraudsters. Unfortunately, existing policies have not been effective in addressing the issue. Matthew (2013) insinuates that what must be done is to restructure policies in an adaptive manner corresponding to skills used by fraudsters in soliciting funds from insurers.
In an effort to develop a comprehensive understanding on the scope of fraud in compensation claims, I called on the California Department of Insurance offices in Los Angeles. Luckily, the department’s offices are usually open for normal business on Saturday until 12 pm. Therefore, I scheduled my visit for 9 am on October 19, 2013. Choice of this place was motivated by the fact that state departments are responsible for policy making processes within their jurisdictions. In this regard, I occurred to me that the California’s department should be of considerable assistance on matters concerning policy framework in tackling fraud within the insurance industry. My stay in their offices lasted for three hours until closing time, after which I had acquired substantial insight on the nature of fraud cases and the role of existing policies in combating this insurance vice.
Within the department, I had the joy of getting direct responses from members of the Special Investigative Unit, which is a unit responsible for handling cases relating to serious fraudulent claims. In addition, I had an opportunity to meet one member of the fraud assessment commission named Matthew. During my interaction with the member, I came to understand that the department only utilizes special investigative unit and the assessment commission upon suspicion of a fraud. In normal circumstances, claimants are only required to fill in claim forms and submit relevant documents like employer’s payroll report before being compensated. Therefore, I came to an understanding that policy makers are usually optimistic that all workers’ compensation claims are genuine unless the claimants are damn enough to raise any suspicion. Undeniably, such an assumption is inefficient and accounts for the reason why compensation frauds are on the rise in California.
On a practical basis, I would agree that the visit supplemented new information that were absent in my literature studies. I came to realize that practical formulation and implementation of policies is usually rigid and involves a lot of bureaucracy. The fraud assessment commission member who responded to my questions admitted that they can only vet suspected claimants after approval by the special investigative unit. In case they have prior suspicion of fraud by a given claimant, they will have to wait until the special investigative unit substantiates intentions of falsity by the accused. In most cases, assessment commission may have prior knowledge of a deceptive claimant; however, the scope of their occupational responsibility does not allow them to share unfounded knowledge with the investigative team. According to Matthew (2013), such rigid bureaucracy undermines smooth and objective combat against fraudsters.
At this juncture, I will be quick to admit that I encountered no problem during the entire period that I conducted my personal interviews with commission’s member and other staff personnel. Based on my observation, I acknowledge the bureaucratic manner in which fraud cases are handled by the state department. In my next visit, I would want to investigate on the processes and stages involved in policy formulation. Furthermore, I would wish to know whether it is possible to change existing policies in order to flexibly handle the rising number of fraudsters in California.