Keeping Job-Related Injury Claims Legitimate

Workers’ compensation insurance covers employees when job-related injuries prevent them from working. This valuable benefit pays lost wages, medical bills, and other expenses while personnel recuperate. When staffers report on-site accidents, workers’ comp tasks can pose overly complex challenges, and rising fraudulent cases can sabotage your business greatly. Thankfully, outsourcing injury claims to National PEO will free up time to spot fake suffering, reducing your loss history while improving workforce productivity.

Insurance Scam Examples

Employee schemes: Ted files a workers’ comp claim after an alleged on-the-job accident. Since he is in too much agony to work, he collects disability benefits. However, the insurer learns that he was not in fact hurt. While receiving unlawful payments, Ted handled deliveries for a different company and ran his own tree-trimming service on the side. His fraud conviction for faking personal harm mandated that he reimburse the insurance company the $7,500 his disability coverage paid him.

Provider rackets: Shady medical practitioners submit claims for falsified treatments that patients never received. Some providers team up with devious attorneys to lure employees to perpetrate frauds. Such claim mills can rake in illegal benefits amounting to millions of dollars that all parties share.

Fake Qualification Consequences

While few American workers and providers cheat the system for personal profit, the damages they inflict can be enormous. Workers’ comp crimes cost billions of dollars annually. Scams lead to higher premiums, which drain business profits while costing trustworthy employees suitable pay and sometimes their jobs.

A staffer feigning a disability is not performing his duties. His absence can reduce your firm’s productivity, placing extra burdens on everyone else. Even one bogus claim can undermine your loss history. If your firm undergoes experience ratings, benefits your insurer paid erroneously might increase your experience modifier and thus your workers’ compensation premium.

Top Employee Motives

Dishonest personnel who file false claims for worksite injuries share one main motive: free money. Greedy staffers like Ted may take second jobs or open side businesses secretly while maintaining that they are too hurt to handle their current positions. They may double their incomes by getting lost wages through their workers’ comp policies while earning even more illegally from concealed assignments.

Other temptations include free vacations. Deceitful workers collecting insurance money for fake impairments may be exploring exotic destinations. Others spend their paid time off enjoying hobbies, sports, and other favorite activities such as skydiving, soccer, and redecorating their homes during supposed recovery periods.

Fraud Prevention Tips

Maintain a positive workplace atmosphere. Satisfied employees are less prone to committing shams than their disgruntled counterparts. Announce your no-tolerance policy. Watch out for certain behaviors that may indicate a staffer’s claim constitutes a workers’ comp hoax. Contact your insurer if any of these situations masks a scam:

Injury occurs early Monday: Someone who sustained an impairment during off hours may blame an on-site trauma so workers’ comp will cover his medical bills. While cleaning his attic on Saturday, hoisting a hefty box might have wrenched his neck, or he may have sprained his ankle during a Sunday softball game. Then on Monday, he pretends that his accident occurred on your loading dock.

Staffer inflates his status: Although an employee suffered a legitimate job-related mishap, a slight twinge in his lower back could be minor. By insisting that his sprain is serious, he could collect more workers’ comp payments and enjoy more time off than he deserves.

No one witnessed accident: An employee stating that he fell in a remote area while alone could signal invented harm. Soft-tissue damage like neck and back muscle problems are common tricks. Because disproving them is hard, they are easy to pull off. Security camera footage may refute this suspicious assertion.

Employee delays reporting incident: Any old, unhealed but unrelated frailty may prompt someone to blame new on-the-job damage to a shoulder or knee. That will give him paid time off for an earlier ailment to finish mending.

Slacker says his condition’s lingering. After recovering enough to resume work, a freeloader may try to extend his leave by pretending he is still disabled.

Worker changes his description. At first, he slipped on a water spill inside. Later, he faults a patch of ice outside.

Anyone also is suspicious if he:

  • Demonstrates dissatisfaction with his job or has a history of behavioral or performance problems
  • Refuses diagnostic test to confirm his injury
  • Submitted other workers’ comp claims
  • Is hard to contact and won’t return management’s emails and phone calls

Categories: Workers Compensation