Workers' Compensation fraud affects approximately 10% of all claims, costing nearly $34 billion annually. While strong safety programs remain the primary defense against claims, organization-wide fraud awareness is equally essential for controlling unnecessary costs when injuries occur.

Three Steps for Reducing Fraud

Step 1 - Create a written policy regarding fraud

• Have written policies and procedures that make it clear to employees you will not tolerate any abuse of the Workers' Compensation system

Step 2 - Post Signs

• Post signs throughout your organization about fraud awareness and how employees can report fraud. Employees are an excellent source for detecting fraud

Step 3 - Educate your employees

• Train your staff on how to detect fraud and how to report it (see below)
• Hold meetings and include topics on fraud and its impact on the financial health of the company. Let them know the harm that fraud causes them and the company
• Make sure your Workers' Compensation carrier claim unit has procedures for investigating, prosecuting, and seeking recovery from over payment, or benefits received fraudulently
• Report any suspected fraud immediately. The earlier the claims representative is aware of potential fraud, the better the opportunity of detection

Fraud Indicators

These fraud indicators should only be considered red flags, and do not prove the presence of fraudulent activity.

The Claimant, Prior Claim History And Current Work Status
The Injured worker...

• Is disgruntled, soon-to-retire, or facing imminent firing or layoff
• Is involved in seasonal work that is about to end
• Took unexplained or excessive time off prior to claimed injury
• Contact us for more...

Circumstances Of The Accident

• Accident occurs late Friday afternoon or shortly after the employee reports to work on Monday (or after days off)
• Accident occurs without witnesses
• Accident occurs in an area where the employee would not normally be
• Contact us for more...