Different Types of Workers Comp Fraud

wcfraudcardWe are always reading stories or posting stories about fraud.  I just wanted to take this time on this post to discuss the different types of fraud that can occur in workers compensation.  We usually are always seeing a worker claiming to be injured collecting compensation while also working a side job for income.  These are probably 90% of the stories we read about, but fraud can happen from all angles and for a variety of reasons and for that I would like to examine a few of the different ways that fraud can and does occur.

Employee Fraud

  • Employees have been know to exaggerate symptoms or severity in order to receive workers comp or to continue receiving comp benefits.
  • One of the most common ones we see is an employee who is receiving comp benefits is also working another job to receive additional income.  This is against the law.
  • Faking an injury to receive initial comp benefits.
  • Employees have been known to see their doctor for a work related injury and throw in another complaint that they have that did not occur during the work injury in hopes it will be paid for by workers comp.

Provider Fraud

  • Providers have been know to add testing or treatments to their bills to pad up the cost for services that were never performed on the patient.
  • If a bill is not paid as fast as the doctor would like it to be through workers comp, they may send it to the patients health insurance – this is against the law.
  • Doctors may also try to pad a bill for more money by performing unnecessary testing or treatments – this is when it is good to have a great adjuster or great technology that looks a each and every line level detail.

Employer Fraud

  • The most typical employer fraud that I come across is when an employer does not have the proper level of workers comp benefits for its employees – it is a federal law that every business cover every employee with comp protection whether its through an insurer, self-insurance or a pool.
  • Employers have also been know to report lower payroll to insurance companies in order to get a more favorable premium on their coverage.

No matter how you look at it fraud is illegal and 9 times out of 10 you will get caught at some point.  You may think that you have gotten away with it because you have received tens of thousands of dollars in benefits, but when you are finally caught you will be required to pay all that money back plus some and possibly jail time.  Fraud also raises the premiums of everyone else.  It is just all around bad for the economic profile of states.  It is much easier to get caught now with all the cameras, social media, and investigations.  Let’s hope that this continues and drives out workers comp fraud even more.



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