The workers' compensation program has always been intended to make things easier on injured employees to file a claim. But some employees take advantage of the system and file fraudulent claims.
Workers comp fraud is estimated to cost billions of dollars each year to insurers and businesses alike. Fraudulent claims also make it harder for workers who are legitimately injured to make their claims without feeling suspect. That makes it worthwhile to know the warning signs or "red flags" that can signal a scam.
Here are some things to keep in mind:
Some occupations are more dangerous than others, some injuries more common.
High-risk occupations include general laborers, nursing aides or other medical workers, janitors, commercial truck drivers, and police or sheriff's patrol officers. Those occupations account for one out of every five claims. Nearly 95% of all workers' comp claims involved an actual injury on the job, while only 5% of claims involved occupational-acquired illnesses, like cancer or something similar.
If your employees are in an occupation that puts them at high risk of injury you are more likely to have a high number of claims. Similarly, you may have more reason to suspect fraud if there's a sudden rush of claims that don't seem to make sense.
Workers' comp fraud comes in several basic forms.
Most workers' comp fraud comes in one of several forms:
- The worker totally fabricates the injury in the first place, such as claiming a back injury that doesn't exist.
- The worker does suffer an injury but exaggerates the seriousness of the issue. For example, a bruise from a fall becomes an incapacitating injury to a hip.
- The worker suffers an injury but continues to claim symptoms prevent him or her from returning to work long after the trouble has abated. For example, the employee continues to claim that a lower-back injury is debilitating when it has healed.
- The worker continues to attend physical therapy, doctors' appointments, and claim disability while quietly working a job on the side and collecting benefits at the same time.
Learn which claims to view with suspicion.
Not all workers are dishonest. However, you should definitely be suspicious of injuries that seem to occur only when there is nobody around as a witness, injuries that don't seem to be healing no matter how much treatment or support the worker has, injuries that seem more severe than they should be given the circumstances of the incident. Also, beware of the worker who seems to never be home when you call. He or she might be working another job and collecting.
Controlling your workers' compensation insurance costs is vital to the welfare of your business, so consult with your insurer any time you suspect a fraudulent claim. Reach out to a company like Professional Risk Organizers, Inc. for more information.