Workers’ Compensation Fraud a Major Crime in America

by | Published on Jun 29, 2016 | Workers Compensation

Medical record review for attorneys is a valuable service workers’ compensation lawyers use to make the important medical record evaluation process easier and quicker. Usually provided by a good medical claims review company, this service helps identify genuinely injured workers and thereby prevent insurance fraud. Today, workers’ comp fraud is a major crime in the United States. Every year, it is estimated that tens of billions of dollars in unpaid premiums and false claims are stolen every year. It is indeed a sad state of affairs that this valuable employee benefit that pays for lost wages, medical expenses and other costs while a worker recovers from his/her injury should be misused. Though only a small number scam this insurance coverage for personal profit, they cause considerable damage to the system as a whole. Insurance fraud results in premiums increasing and costing honest employees their pay and jobs. So what are the common types of workers’ compensation scams?

  • False claims: These claims are made by dishonest workers against their employer’s workers’ compensation policies. They may get injured off the job but claim that they are hurt at the workplace; they may exaggerate minor injuries they may have sustained at the workplace; they may invent injuries such as muscle problems with the neck and back which are hard to disprove; they may present an old injury as one they sustained at the workplace; or they may indulge in malingering and stay at home even after they are completely healed.
  • Employers reducing workers’ comp premiums they owe the insurer: Businesses sometimes hide their premium scams behind dummy companies, bogus accounting, tax records and other possible cover-ups. These scams are difficult to discover. A business employer may tell the workers’ comp insurer that many employees work safer jobs than they really do; or they may claim that they have fewer employees or a lower payroll than they actually do; or they may simply avoid coverage by not buying workers’ comp insurance in the hope that state officials would not notice.

To ensure a safe workplace and good workers’ comp coverage, employers and employees have to work together. Workers hurt on the job can seek the treatment and compensation they deserve and for this they should know their rights as an injured worker in their state. Employers should ensure a safe and supportive workplace and make their workforce happy, thereby reducing the chances of workers’ comp fraud at their business. They can build strong teamwork among their employees about safety and make it clear that they would not tolerate fraud in any way.

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