Not only is work comp fraud illegal – it costs US taxpayers billions of dollars a year. All too often we hear employers and clients complaining about fraud.
The most common examples are:
An employee was injured off duty and turned in a claim the following morning or after the weekend. In most circumstances these individuals are not covered by health insurance – and understand that if they miss work due to an injury outside of work they will not be paid for it.
An employee suddenly has a back “injury” or soft tissue “injury” months after an “accident” happened and they never reported it to their supervisor. This normally happens because during the initial accident the injuries were minor and not needing attention – over time they can get progressively worse – OR – that employee needed 30 days to clean their system of drugs so they could pass a drug test for work comp purposes. Another alternative is that there are pre existing conditions that have worsened and without health insurance their only option for surgery is to say they were injured at work.
What can you do?
- When turning in a claim be sure to communicate with your insurance agent. If there is suspected fraud on a claim the agent and carrier need to be made aware the same day – or as soon as you become aware of the fraud. Clients should be notifying their agent 100% of the time there is an insurance claim. If we don’t know – then we cannot advise.
- Create a game plan with timelines. Once you have received your adjuster information schedule a conference call to identify potential fraudulent factors. Here are some common starting points: Where there witnesses present? Was their video surveillance of the injury? Does the employee have pre existing conditions? Are any other employee’s close with this employee? Is there conflicting information on social media?
- Investigate: If there are factors that are sketchy – let your adjuster know what they are. Many insurance companies have private investigation contracts with companies that can put surveillance on an employee suspected of committing workers compensation fraud.
- Monitor the employee’s social media for conflicting photo/video. If an employee is truly injured there shouldn’t be pictures of them performing demanding physical activities on social media.
- Hire trustworthy employee’s. Work with trustworthy consultants. Before hiring a consultant for your business ask for references. Make sure your business partners are vetted. When hiring new employees, employers always should check their work history and references and conduct a background check.
- Give employees multiple ways to report fraudulent activity. Employers should create an environment where employees do not fear retaliation for reporting potential workers’ compensation fraud. This can be accomplished by establishing safe and potentially anonymous ways for employees to report suspicious activity.
