Injuries happen on the job in every profession. It could be a construction worker falling from scaffolding, an office worker slipping in the office’s break room, or a waitress injured in a fall in a dining room. Employees are legally entitled to these benefits; however, some try to use worker’s compensation insurance to game the system by exaggerating the scope of their injuries. Regardless of the industry, businesses and their workers’ compensation carriers can be a target for insurance fraud. According to the National Insurance Crime Bureau, workers’ comp insurance fraud costs an estimated $30 billion annually in the United States.
5 common examples of fraudulent claims
Understanding common signs and tactics can identify and limit fraud and its fallout. Examples include:
- Personal time fraud: This involves workers getting injured on weekends or off the clock and then claiming that injury occurred on company time. These types of claims often happen on a Monday.
- Exaggerating the scope of the injury: This typically involves lying about the severity of the injury or its existence. It may involve hard-to-diagnose injuries involving traumatic brain injuries or spinal injuries.
- Double dipping: Workers may try to collect temporary or long-term disability benefits while still working. This may involve employees defying doctor’s orders to stay home or working elsewhere while “staying home.”
- Medical provider fraud: Healthcare professionals are not above inflating the extent of the injuries, illness or length of the recovery.
- Fraudulent certificates: Businesses using subcontractors may find that those workers are inaccurately categorized as an employee who qualifies. This means the subcontractor is covered by a policy when they shouldn’t.
Companies can dispute suspicious claims
Due diligence is a part of any well-run business. Employers concerned about potentially fraudulent claims should consult with their workers’ compensation insurance carrier and insurance defense attorneys for guidance on potential defenses, obtaining and preserving evidence of fraud, and remedies.