Workers Compensation Fraud

Workers’ compensation fraud is a serious offense. It occurs when someone knowingly and intentionally makes a false statement in order to obtain or deny a benefit for themselves or another individual. There are two common types of workers’ compensation fraud schemes, which are claimant fraud and premium fraud.

Claimant Fraud: Claimant fraud occurs when an employee receives workers’ comp benefits under false pretenses. The dishonest claimant may not tell the truth about the injury occurring on the job, when the injury actually occurred at home or somewhere else.

Or, the claimant may lie about the injury itself. The particular person may exaggerate the extent and seriousness of the injury or receive money from other sources while lying to the insurance company about such income. Dishonest medical providers such as doctors, pharmacists, etc. can try to be paid for excessive or even nonexistent treatments, and attorneys can become involved in scams as well by trying to secure benefits that the claimant is not entitled to.

Premium Fraud: Premium fraud occurs when employers use a variety of schemes to defraud their workers’ compensation insurance company by either not paying for workers’ comp coverage at all, or by paying less than they actually should. The primary cheats are:

• Reporting to the insurance company a payroll figure that is less than the total payroll actually being paid to employees of the business

• Misclassifying workers by not revealing all job duties that an employee performs

• Paying workers in cash while identifying them as subcontractors

• Paying or using illegal aliens as employees

• Failing to report on-the-job injuries to the insurance company

• Failing to have workers’ comp insurance when it is required

A background search is conducted to see if the employee has any history of filing any workers compensation claims statewide. The search is carefully evaluated and is looked very carefully for any type of repetitious pattern of such claims.

Any suspicious claims are handled by our office and field investigators. We document the daily activities of workers compensation claim individuals to identify if they are in fact capable to work for their employer. Please call our firm with any suspicions that you may have of a claimant or business.