Workers’ Comp Fraud: Tips to Clip It

scissors-235211_1280Legitimate Workers’ Comp claims can cost your business big money.  Fraudulent claims can drive up your costs even more and for  years ahead.  What are the most likely ways employees can claim bogus Workers’ Comp?  Following are claims to give special attention to:

Back and head injuries. Back injuries in particular are one of the most common claims.  It’s difficult to disprove a back injury, but easy to collect money for it.

Keep a close watch on workers who cry of back and head injuries.  Their actions might foul up their claims.

  • Example: A father and son team of garbage collectors filed a claim for work-related back injuries.  Investigation revealed these men were receiving benefits even though they had opened a sandwich shop.  But the frosting on the cake was a film secretly taken of the suffering duo.  It showed the two men in front of their new business, lifting hundreds of pounds of equipment onto a truck.

The Monday morning injury. Some workers injure themselves on the weekend, but on Monday, claim the injury was work-related.

  • Example: One employee came to work on a Monday morning, and within minutes of his arrival, he claimed to have hurt his knee from slipping on a scrap of paper.  But subsequent inquiries showed that the accident happened during a Sunday football game!

Vague, unsupported claims. They’re another clue to at-home-accidents falsely reported as work-related.  If a worker reports an accident weeks after it supposedly happened or if an employee doesn’t tell you which stamping machine, in which department and on which day he or she injured the finger, you can guess something might be amiss.

The malingering injury. A worker who watches TV at home while collecting benefits has no reason to return to work.

To avoid this problem, stay in close touch with the employee’s doctor.  In this way, you are informed on the progress of a workers’ recovery.  You also learn when an employee is able to return to work.

The psychological claim. Some workers figure on an early retirement by scheming for a lifetime indemnity payment.  They sometimes claim that a simple work injury leaves lasting psychological scars.

  • Example: A driver says he’s afraid to sit behind a wheel because of his or her involvement in a work-related fender-bender.
  • Solution: Offer the employee either medical or vocational rehabilitation.  Tell the worker that his or her job remains open.  Or offer the worker another job.

Hearing officers, who know you offered rehabilitation and know that the worker refused, will be more likely to dismiss this phony claim.

Occupational disease claim. The occupational disease claim is becoming more and more common.  Why? Like the psychological claim, the successful claimant receives lifetime indemnity payments.

Carefully review these claims.  Though the employee may suffer from a disease, often the disease isn’t work-related or it results from a past work experience.

  • Example: An employee of six years filed an asbestos-related disability claim.  But the company hadn’t used asbestos insulation in its plant.  An investigation revealed that a previous employer used the insulation. Subsequently, the earlier employer became responsible for the Workers’ Comp payments.

Other recommendations: Stay on top of Workers’ Comp claims.  When workers know that you thoroughly examine and investigate all claims, they’re less likely to make false claims.

Also, cultivate a good relationship with your insurance carrier. If you suspect a bogus claim, confide your doubts to your carrier.  Often the carrier provides investigation services or advises you on the best way to handle the problem.


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