How an Employer Can Lower the Risk for Workers’ Compensation Fraud

There are a lot of benefits of holding a proper Workers’ Compensation insurance policy as a company from having medical bills and at least some lost wages covered when an employee is injured at work. However, with that coverage also comes the risk of abuse by unscrupulous employees looking to rig the system. The first step to working against such abuse is to understand the types of fraud that commonly occur.

Types of Fraud

Fraud can happen at any point in the claim process, from the injury itself to claims made about the severity of the injury. Here are some common forms of fraud to look out for:

• The alleged accident may not have been an accident at all. In this case, the injury itself is fabricated.
• Some employees try to pass off old injuries as new injuries. Red flags for this type of scam include no witnesses to the injury, report on a Monday morning yet the injury does not appear new and having medical details that don’t match the narrative presented by the employee.
• In some cases, medical providers may also be participating in fraud by providing bills for services such as tests that were not performed. This may be done with or without the employee’s knowledge.
• Exaggeration of severity is likely the most prevalent in fraud cases. The most common is claiming to still be healing despite being able to return to work at full capacity.

Prevention

The first step in preventing fraud in Workers’ Compensation claims is to have a very clearly written company policy on Workers’ Compensation for all employees. This policy will help aboveboard employees understand the process while providing an avenue in which to inform underhanded employees that investigations and legal action will be taken to avoid cases of fraud. In that policy, be sure to let your employees know that there is an immediate need to report injuries and accidents, and that there will be no negative consequence for doing so.

Further, be sure to follow up and conduct investigations into claims. This is to ensure all aspects are accurate and are being handled, which will aid those using the system properly for those with a legitimate injury while making it more difficult for those attempting fraud. If you have been accused of fraud for a legitimate injury, you need legal representation. Contact our team today for more information.