There are many ways that an employer can properly reduce the cost associated with workers’ compensation, such as properly reporting injuries and the number of employees to the employer’s workers’ compensation insurance company. Another very important step to reducing costs is taking steps to recognize and curtail workers’ compensation fraud. The Central Index Bureau is a tool used by workers’ compensation insurance companies to assist in spotting fraudulent workers’ compensation claims.
The Central Index Bureau is a division of the Insurance Services Office, which was formed as an organization for the purposes of advising and rating insurance industries in order to provide statistical services and help combat fraud. The reports from the Central Index Bureau can also be called “an ISO” or a “claim index.” The terminology will vary between insurance companies, and almost all insurance companies are members of the ISO Central Index Bureau. These reports contain a record of every insurance claim filed by any individual, including workers’ compensation claims. When an employee makes a workers’ compensation claim, a CIB report will be generated by the workers’ compensation insurance company. This report contains the employee’s name, social security number, aliases, addresses, occupation, and other vital statistical information. The report will also identify all past claims made by the employee, including the type of injury, the source of the injury (such as automobile accident, medical malpractice, etc.). The report will also identify the employee’s medical providers for the past injuries and the names of any attorneys who may have represented the employee.
An insurance adjuster can use all of this information to help spot and stop workers’ compensation fraud. The adjuster will examine this report for repeat injuries. For example, if the employee has made many workers’ compensation claims, all stating that the employee has a soft-tissue injury, this could be a red flag for fraud, or at the very least indicates a potential pre-existing injury. The adjuster will also be on the look-out for multiple doctor changes. Employees who commit workers’ compensation fraud will often switch doctors with a high frequency. This is so the new doctor will not be familiar with the employee’s history of injuries.
If you have questions about how to best protect your business from fraudulent claims, contact us today at (714) 516-8188. We will discuss your business and how to stop fraud in the work place.