Fraud can take several forms in workers’ comp, but the bottom line is the same:
>>>>>>>>>>>>>>Someone is trying to cheat the system to gain an unfair advantage.
• Employees may commit claimant fraud by attempting to obtain workers’ compensation benefits to which they’re not entitled.
• Employers may commit premium fraud by intentionally misrepresenting their payroll, the nature of their work, or their number of employees.
• Medical practitioners and other service providers may commit provider fraud through falsified or unwarranted billing practices.
As an employer, you can make a difference in preventing fraud:
1. Educate your employees about workers’ compensation so they know the benefits for legitimate claims and the penalties for fraudulent ones.
2. You can also be on the lookout for fraud and report suspicious cases. Each insurance company has a staff of fraud investigators and operates a toll-free fraud hotline.
3. Our clients report that installing security camera system has reduced workers’ comp. claims 70%. Modern security cameras with extended recording capabilities, with installation can be obtained today for considerably small price. Such also prevents property claims, as those prevents burglary and vandalism.
J. was a convenience store clerk who felt he should only work when he wanted to. Before starting his shift on a Friday evening he devised a plan to skip work and stillbe paid. Early in his shift he paced up and down a store aisle watching customers and his co-worker at the register. Once he realized his coworker was distracted he walked over to a wire rack and shook it to see if it would fall. Realizing no one was watching he pulled the wire rack down on himself and started screaming for help. Eventually, an ambulance was called to transport him to the hospital.
What J. did not realize was the store not only had a video camera over the cash register but also over the store aisles. His staged accident was caught on video tape. J faces up to 5 years in prison for workers compensation fraud if convicted by a court of law.
Some potential fraud red flags to be on the lookout for include:
- The employee has injuries that do not match with the story of the accident
- There are no witnesses to the accident
- The accident occurred early on a Monday morning or after a holiday weekend
- The accident leads to rumors or whispers around the workplace that the injury was faked.