What You Need to Know
Workers' compensation fraud is a big problem. The National Insurance Crime Bureau (a not-for-profit organization that investigates and tracks insurance fraud nationally) asserts that workers' compensation fraud is the fastest-growing insurance scam in the country. The NICB estimates that 10 cents out of every premium dollar is wasted on fraud. That translates into billions of dollars lost to workers' compensation fraud annually. Who pays the tab? We all do.
Education is one of the ways we can combat the problem. At Eastern, we believe the more people know about fraud, the more likely they'll be able to recognize it and report it. One important thing to keep in mind is that workers' compensation fraud is not just perpetrated by employees - employers and medical providers can be guilty of fraud too.
Here are some of the red flags to look for in each group:
Employee Workers' Compensation Fraud
Harry Smith is a welder for a small company. Lately, Harry has received "poor performance" reviews. He's also told some of his co-workers that he and his wife are divorcing and that he will have to be responsible for child support. In the past, he's complained about work stress and back problems. Now, he shows up on Monday and tells HR that he injured his wrist late on Friday afternoon, after everyone else had gone home.*
*Not a real case.
Poor performance reviews.
Harry's walking on thin ice at his job and may be seeking to get whatever he can before the company dismisses him.
That divorce and child support Harry mentioned to his co-workers? Harry may be signaling he needs money fast.
A suspicious prior history.
Harry claims to have had stress and back problems. A prior history of reporting subjective injuries should raise concerns about his claim.
Reporting a work injury on Monday that occurred on the previous Friday.
Harry shows up on Monday, claiming he sustained an injury on the job the previous Friday and that there were no witnesses. Under these circumstances, Harry's injury looks highly questionable.