Workers compensation fraud

However, a more positive outlook on managing workers compensation claims can be developed. Although there is a great deal of workers compensation fraud, the great majority of injuries that are reported are legitimate. The anployee truly is hurt. A few isolated cases of fraud should not tarnish the reputation of a system that is designed to help employees in their time of need. 

Such incidents are typically defined as fraud, but workers compensation fraud can extend beyond acts committed by an employee. A physician may commit fraud by wrongly reporting and treating an injury as being more severe than it actually is in order to submit bills and collect compensation. It can be financially beneficial to the physician to extend the life of the claim in order to generate more revenue through billing for treatment that was provided. 

Employers can commit workers compensation fraud. A lot of money is at stake, whether it is through workers compensation insurance premiums or the payment of claims. An employer may be tempted to falsify facts in order to receive lower exposure to losses associated with workers compensation claims and insurance coverage. 

Because an effective safety program in the plant or facility must include training, the ultimate objective of training is to influence the attitudes of employees around the clock. Off-the-job accidents cost industry many times more than on-the-job injuries. Although workers compensation is not involved, absenteeism from off-the-job injuries results in productivity losses and insurance cost increases. Employees injured off the job may, with the assistance of unscrupulous lawyers, sometimes claim the injury occurred during work time. Such fraud can be combatted by effective record keeping and supervisory vigilance. 

Some have reported 1-2% of workers compensation claims involve fraud. Such cases add to the cost of providing legitimate benefits to injured workers. Some cases involve one individual. Others involve several individuals working together. Fraud may involve claimants, employers, medical and health care providers, or attorneys. 

Insurance fraud can become an elaborate scheme involving many people. Some involved in a workers compensation case may prefer doctors who give favorable decisions on disabilities and preferred attorneys who route injury cases to them. Fraud extends to other kinds of insurance. The following case illustrates the possible complexities. 

School administration can take advantage of the assigned workers compensation insurance claim adjuster. This persou will have an objective perspective of a claim and will be able to identify issues with a claim that might point to the potential for fraud. 

Now, to the rest of you who slap each others backs and hail each other fellows well met because your workers compensation costs went down, shut up and sit down. Your costs didn t go down because you reduced injuries or risk. Your costs went down because incidence of fraud went down. 

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