Skip to main content

Preventing Workers’ Compensation Fraud

By July 30, 2020September 29th, 2020No Comments
This content was originally published by Eastern Alliance.

Workers’ compensation fraud is one of the fastest-growing insurance scams in the country. Eastern, PEC’s workers’ compensation insurance carrier, believes the more an organization knows about fraud, the more likely they’ll be able to recognize and report it.

Workers’ compensation fraud costs jobs, causes higher prices and it affects you, your workforce and others in your industry. According to the National Insurance Crime Bureau, workers’ comp fraud is the fastest-growing insurance scam in the country. And it’s estimated that 10 cents out of every dollar is wasted on fraud. That’s billions of dollars lost annually.

When it comes to employee fraud, there are several warning signs. For example, Harry Smith is a welder for a small company. Recently, he received poor performance reviews. Harry also mentioned to his co-workers that he and his wife are divorcing, and he will need to pay child support. In the past, he also complained about work stress and back problems. On Monday, Harry tells HR that he injured his wrist at work late Friday afternoon, after everyone else had gone home. What were the warning signs?

  • Poor Performance Reviews – Harry’s job could be in jeopardy – so he may be seeking to get whatever he can before his employer terminates him.
  • Financial Difficulties – That divorce and child support Harry mentions to his co-workers? He could be hinting that he needs money fast.
  • Suspicious Prior History – Harry claims to ave experienced stress and back problems. A prior history of reporting subjective injuries should raise concerns about his claim.
  • Reporting a Work Injury Days Later – Harry arrives at work Monday, claiming he sustained a work injury the previous Friday, and there were no witnesses. Under these circumstances, Harry’s injury appears questionable.

Other types of warning signs may include an injured employee who:

  • Complains frequently about new job responsibilities or returning to work
  • Has little or no improvement to their health
  • Inquires about a “quick settlement”
  • May be retiring, disgruntled, on probation, involved in labor dispute, or subject to disciplinary action
  •  Stays out of work longer than the doctor prescribed
  • Refuses medical tests or examinations to confirm an injury
Skip to content