808-218-1025
Hawaii Workers' Compensation
Investigation
Hawaii's Workers' Compensation Law, HRS 386
AOE/COE
§386-98 Fraud violations and penalties.

(a) A fraudulent insurance act, under this chapter, shall include acts or omissions committed
by any person who intentionally or knowingly acts or omits to act so as to obtain benefits, deny
benefits, obtain benefits compensation for services provided, or provides legal assistance or
counsel to obtain benefits or recovery through fraud or deceit by doing the following:

  1. Presenting, or causing to be presented, any false information on an application;
  2. Presenting, or causing to be presented, any false or fraudulent claim for the payment
    of a loss;
  3. Presenting multiple claims for the same loss or injury, including presenting multiple
    claims to more than one insurer except when these multiple claims are appropriate
    and each insurer is notified immediately in writing of all other claims and insurers;
  4. Making, or causing to be made, any false or fraudulent claim for payment or denial of a
    health care benefit;
  5. Submitting a claim for a health care benefit that was not used by, or on behalf of, the
    claimant;
  6. Presenting multiple claims for payment of the same health care benefit;
  7. Presenting for payment any undercharges for health care benefits on behalf of a
    specific claimant unless any known overcharges for health care benefits for that
    claimant are presented for reconciliation at that same time;
  8. Misrepresenting or concealing a material fact;
  9. Fabricating, altering, concealing, making a false entry in, or destroying a document;
  10. Making, or causing to be made, any false or fraudulent statements with regard to
    entitlements or benefits, with the intent to discourage an injured employee from
    claiming benefits or pursuing a workers' compensation claim; or
  11. Making, or causing to be made, any false or fraudulent statements or claims by, or on
    behalf of, a client with regard to obtaining legal recovery or benefits.


(b) No employer shall wilfully make a false statement or representation to avoid the impact of
past adverse claims experience through change of ownership, control, management, or
operation to directly obtain any workers' compensation insurance policy.

(c) It shall be inappropriate for any discussion on benefits, recovery, or settlement to include
the threat or implication of criminal prosecution. Any threat or implication shall be immediately
referred in writing to:

  1. The state bar if attorneys are in violation;
  2. The insurance commissioner if insurance company personnel are in violation; or
  3. The regulated industries complaints office if health care providers are in violation, for
    investigation and, if appropriate, disciplinary action.

(d) An offense under subsections (a) and (b) shall constitute a:

  1. Class C felony if the value of the moneys obtained or denied is not less than $2,000;
  2. Misdemeanor if the value of the moneys obtained or denied is less than $2,000; or
  3. Petty misdemeanor if the providing of false information did not cause any monetary
    loss.

Any person subject to a criminal penalty under this section shall be ordered by a court to
make restitution to an insurer or any other person for any financial loss sustained by the
insurer or other person caused by the fraudulent act.

(e) In lieu of the criminal penalties set forth in subsection (d), any person who violates
subsections (a) and 9b) may be subject to the administrative penalties of restitution of
benefits or payments fraudulently received under this chapter, whether received from an
employer, insurer, or the special compensation fund, to be made to the source form which the
compensation was received, and one or more of the following:

  1. A fine of not more than $10,000 for each violation;
  2. Suspension or termination of benefits in whole or in part;
  3. Suspension or disqualification from providing medical care or services, vocational
    rehabilitation services, and all other services rendered for payment under this chapter;
  4. Suspension or termination of payments for medical, vocational rehabilitation and all
    other services rendered under this chapter;
  5. Recoupment by the insurer of all payments made for medical care, medical services,
    vocational rehabilitation services, and all other services rendered for payment under
    this chapter; or
  6. Reimbursement of attorney's fees and costs of the party or parties defrauded.

(f) With respect to the administrative penalties set forth in subsection (e), no penalty shall be
imposed except upon consideration of a written complaint that specifically alleges a violation
of this section occurring within two years of the date of said complaint. A copy of the complaint
specifying the alleged violation shall be served promptly upon the person charged. The
director or board shall issue, where a penalty is ordered, a written decision stating all findings
following a hearing held not fewer than twenty days after written notice to the person charged.
Any person aggrieved by the decision may appeal the decision under sections 386-87 and
386-88. [L 1963, c 116, pt of §1; Supp, §97-113; HRS §386-98; am L 1982, c 98, §1; am L
1985, c 296, §7; am L 1995, c 234, §16; am L 1996, c 260, §5]
Hawaii Workers' Compensation Fraud










    Worker Compensation investigations center around determining the facts surrounding an alleged injury by a worker on the
    job. The term AOE / COE refers to a presumption in the law, below, that a workers'  injury is "Arising Out of Employment" or it
    is in the "Course Of Employment"  when it occurred at work.

    HRS §386-3 Injuries covered. (a) If an employee suffers personal injury either by accident arising out of and in the
    course of the employment or by disease proximately caused by or resulting from the nature of the employment, the
    employee's employer or the special compensation fund shall pay compensation to the employee or the employee's
    dependents as provided in this chapter.
         Accident arising out of and in the course of the employment includes the wilful act of a third person directed
    against an employee because of the employee's employment.

    The Investigators, LLC will quickly determine whether an employee is actually injured, and that the injury occurred at work, or
    is simply defrauding your company.

    Investigations include details regarding accidents, occupational diseases, unexplained deaths, recreational injuries and
    other unusual circumstances. Everything is fully explored by investigators familiar with Workers’ Compensation Laws and
    Regulations in Hawaii. The investigation provides you with detailed information concerning all the facts and circumstances
    surrounding the claimant’s claim for benefits including results of any subrosa or surveillance conducted.

    When initiating surveillance at a location, our Investigators will confirm subject is present and will not wait for more than 2
    hours when there is no activity or subject has not been observed unless instructed to do so.  Thus reducing time spent and
    saving client's funds when subject may not be present or active. Short video clips will be taken to confirm investigators
    presence and time at location.  Surveillance will resume at another time or day until subject is observed.  Video of the subject,
    their associates and all activity will be taken.  Snap-shots from the video can be sent via email to keep our clients informed
    and kept up-to-date on case progression.  The video may be requested at the end of the investigation.  Investigation will not
    exceed the retainer amount without prior approval.

    Most importantly, Private Detectives or Private Investigators' methodology must avoid unprofessional conduct that have given
    rise to various tort actions, such as defamation, invasion of privacy, trespass, and intentional or negligent infliction of
    emotional distress (See page on TORTS).

    We, at The Investigators LLC, are committed to the axiomatic norms of professionalism. We believe in professionalism,
    integrity and ethical conduct in our investigations and relations with those we serve.
Call Us Today!

We are available 24/7 and can meet you at a place and time of your choice and convenience.  

We provide Free confidential consultations and can help you with an appropriate and legal plan of action and can tailor
investigations to meet your objectives.


Call or SMS Text 808-218-1025

email me at:
george@theinvestigatorsllc.com
investigators@hawaiipi.org

Hawaii state License number:PD-312