Common Workers’ Comp Fraud Tactics

Common Workers’ Comp Fraud Tactics

by Leslie Freeland, February 12, 2019

Fake claims. The old is new. Prolonged treatments.

Workers’ comp insurance is a way for employers to protect their employees who get hurt while working on the job. You may or may not have heard the term “worker’s comp” before, but you’ve most likely heard of people getting caught committing fraud by faking a job injury.

Workers’ comp insurance is designed to pay for the injured employee’s lost wages, medical bills and expenses while they heal; unfortunately – workers’ comp is permeated with fraud.

Understanding Workers’ Comp Fraud

There are several ways that an employee can commit workers’ comp fraud. Common fake claims include:

  • Fake Injuries: This is where someone invents an injury. They might stage a “fall.” Back or neck injuries involving the muscles are very common fake claims because they’re hard to disprove.

    • For example: A person loosens the bolts on their desk chair then falls out of it, claiming injury.
  • Inflated Injuries: This is a case of someone getting a very minor (but real) injury on the job. However, they claim that it’s much worse than it really is to get more benefits.

    • For example: A person trips while walking in the hallway. They actually get a mild sprained ankle but claim they pulled a leg muscle.
  • Injured off the Job: This type of fraud is when a person gets injured doing something at home like lifting a heavy box the incorrect way but claims the injury happened at work because they want worker’s comp to cover their medical bills and lost wages.
    • For example: A person moves heavy furniture around their home and strains their back. They work in a warehouse and are responsible for unloading trucks, but they claim the back injury happened on the job and not at home.
  • Malingering: Malingering is where a person draws out their recovery period for weeks, months or even years. They get to stay home pretending to be injured or disabled when they’re really well enough to work.

    • For example: A person was genuinely injured on the job and suffered a neck injury. The neck injury healed successfully in the expected amount of time, but the person claims their neck is still injured, long after recovery.
  • Old Injuries: An example of this is when a person has an old knee or shoulder injury that didn’t heal correctly. They claim that they injured it on the job and that it’s a new injury.

    • For example: Several years before, a person injured their knee while playing tennis for fun. They received treatment for it at the time, but they want further treatment, so they claim the knee injury is recent and happened at work.

 

Getting Caught

Building a business success. The hands with puzzles

No matter how the employee commits the fraud, there is a high risk of getting caught. Many companies even hire private investigators to follow employees around if that company is suspicious of possible fraud.

People can get caught performing workers’ comp fraud in a variety of ways, such as:

  • Social Media Posts: They post a picture of themselves on vacation or doing a sport.
  • Second Job (aka Moonlighting): They are caught working a second job.
  • Volunteering: They are caught volunteering. While volunteering is good, volunteering while you claim you are hurt is not.
  • Security Cameras: If a person faked their injury, often, that company will have security cameras that can prove the claim is a lie.
  • History of Previous Claims: The person has filed for workers’ comp benefits in the past, often multiple times.

 

Not Worth It

Since worker’s comp is highly illegal, it can result in huge fines and jail time if a person is caught. They could also end up with a felony on their record depending on the state they live in. For most people, the possible benefits simply don’t outweigh the risks.

 

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Just as we want to protect you against scams, Asurea is dedicated to protecting you, and your loved ones with insurance. Asurea offers Life Insurance, Mortgage Protection Life Insurance, Medicare Supplement Insurance, Final Expense Insurance, Disability Insurance, Retirement Planning products and more. For additional information, click on the ‘Get A Quote’ button below. Want to have articles just like this delivered to your inbox? Just enter your email address in the box below and click ‘Subscribe.’

All content provided in this article is for general, informational purposes only.

Leslie Freeland

Leslie Freeland

Marketing Communications Coordinator at Asurea
Leslie joined Asurea as the Marketing Communications Coordinator in February 2015. Since then, she has been working closely with insurance professionals to educate the public on the importance of life insurance and protect the public from common scams with informational articles.
Leslie Freeland

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