Typical Ways Fraud Occurs in Workers’ Compensation Claims

Workers’ compensation is a good and necessary system to provide an important safety net to workers who have sustained a work-related injury. Unfortunately, it can also provide a potential target for dishonest people trying to “work the system.”  There are some typical ways that scammers will try to perpetrate fraud, and you and your business need to be alert.

The most common type of scam will be a fake claim of injury. This will work in a number of ways. One way is for a worker to allege that previously sustained injury is actually a work-related injury.  This may also come in the form of a worker sustaining an injury off the job but then claiming the injury happened on the job. Examining old medical records during the case can give clues to whether a worker has previously received treatment for his or her injuries, and the importance of this step cannot be understated. Dishonest workers may also straight out fake an injury. Some injuries are easier to fake than others, such as back and neck muscle injuries. Because these injuries are more difficult to disprove than, say, a broken bone, it is easier for a dishonest person to fake an injury. For this reason, expert testimony may become a key element of your case to defend your business from false claims. Malingering is another type of common fraud. This means when a worker who may have received a valid work-related injury, pretends to be disabled despite actually being healed and able to return to work.

Unfortunately, other participants in the workers’ compensation system may also be part of the fraud. Dishonest doctors or clinics will sometimes try to pad their bill. This typically comes in two forms: inflated injuries or non-existent injuries. A dishonest medical provider may exaggerate the seriousness of an injury and bill for extra, unnecessary procedures in order to receive additional payments from insurance companies.

Dishonest business owners will also sometimes commit fraud by illegally reducing the amount of insurance premiums they owe. They will do this by falsely classifying jobs as safer than they are or lying about the number of employees they have. This affects all insurance premiums, even for honest business owners, as the cost of fraud is passed on to other insurance clients in the form of higher premiums.

If you believe that fraud may be involved in your workers’ compensation case, call me today at (714) 516-8188. We can talk about your case and examine the risks and possibility for fraud.

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