Workers Comp Insurance and Minimizing Fraud

The problem with dealing with workers’ compensation fraud is that it can be somewhat difficult to prove but fortunately there are actions employers can take to reduce the risk.

Employees should understand the benefits of the program as well as their own obligations. The policy should clearly outline that suspicions of fraud will be investigated and legally pursued wherever warranted.

A workers comp insurance claim needs to be filed in a timely manner so agents need to let employers know that they need to ensure that employees understand the need to immediately report any accidents or injuries as soon as they occur. Getting an injury treated quickly is key to helping the individual recover quickly and also likely minimize the cost.

Conduct investigations related to claims

Claims investigation should be done to ensure they’re accurate and being handled consistently within the law. Investigating the details will have multiple benefits including reducing fraud, and could also lead to procedural changes that may reduce the likelihood of that particular injury happening to someone else. Conduct interviews with any witnesses that can help to explain what happened.

Have employers provide a way for employees to anonymously report suspicions of fraud and suggest that they consider using surveillance equipment at the worksite along with having a drug testing policy that includes testing any time an accident occurs. This could improve overall safety and reduce all workplace injuries, and not just fraudulent ones. Also they should look for inconsistencies or other red flags, such as:

  • Stories that contradict one another
  • Injuries that are not medically consistent with the other details of what happened
  • No witnesses to the accident occurring, or
  • Injuries and claims that occur immediately before a major change, such as a seasonal layoff, a strike, or other situations in which the employee would lose pay

Tell employers about the benefits of creating a program to get injured or ill employees back to work as quickly as is feasible, along with having a regular schedule of communications and a monitoring process that tests the worker’s abilities in order to help determine whether they’re able to return to work.

They need to be thorough when screening new hires, using background checks to look for evidence of filing fraudulent workers comp insurance claims in the past. Even if the claims are legitimate, it could mean this individual does not follow safety guidelines. Providing employers with this type of information can reduce their workers comp costs.


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