Preventing Workers’ Compensation Fraud

07/11/2011

According to some statistics, workers’ compensation fraud contributes significantly to the annual estimated 30 billion dollar insurance fraud problem. Fraudulent workers’ compensation claims drain time and resources that are meant to assist workers legitimately injured on the job, and cost employers in higher insurance premiums.

Though insurance fraud can be a staggering problem, there are steps employers can take to lessen the risk of suspect or bogus workers’ compensation claims.
1.             Challenge the common misconception that workers’ compensation fraud is a victimless crime and educate employees on the large-scale consequences.  Using posters and newsletters spread the word that you and your insurance carrier will vigorously investigate suspect claims and refer employees who bring fraudulent claims to appropriate law enforcement agencies for prosecution.
2.             Pay attention to the rumor mill.  Following a workplace injury, and throughout the claims process, rumors often circulate among employees. Sometimes rumors are grounded in fact. Paying attention to worker scuttlebutt can help in investigating a claim’s validity.
3.             Implement an efficient injury response plan and clearly communicate the proper practices to employees.  Provide procedures for reporting occurrences.  Designate appropriate personnel to process accidents and claims, secure a description of the accident, take photographs and obtain statements from the injured worker and witnesses.  Promptly provide appropriate medical care and encourage employees to seek treatment.
4.             Consider using video monitoring equipment. Surveillance tactics are often utilized by insurance companies to “catch” fraudulent claimants; employers can utilize similar tactics to deter fraud. Although such tactics may seem intrusive, if properly conducted at times and places where there is no reasonable expectation of privacy, it is not an illegal invasion of privacy.
5.             Know how your insurance carrier handles claims.  Keep the lines of communication open with your carrier or the attorney assigned to represent your interests in workers’ compensation claims.  Be responsive to information requests.

Finally, keep in mind that although workers’ compensation fraud can be costly, and frustrating, remain wary of becoming too cautious.  Be careful about accusing anyone of workers’ compensation fraud, particularly if coupled with termination of employment.  If you cannot prove it, and often times you can’t, there may arise a strong inference that you acted improperly in response to a legitimate claim.  Be careful not to become tainted by staggering fraud statistics and keep in mind the beneficent purpose of workers’ compensation laws.

For additional information, or to report workers’ compensation fraud, you can contact the Virginia State Police Insurance Fraud Program. Here is the website: Virginia State Police Insurance Fraud Program.

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