Fraud eats away at workers’ comp costs for all businesses, but it hits small firms the hardest as they may not have the resources to identify bogus claims.
According to a new study by workers’ comp insurer Employers Holdings Inc., about 20% of small-business owners are unprepared to identify workers’ compensation fraud.
It’s estimated that at least 10% of claims are fraudulent, so identifying those illicit claims would keep your workers’ comp claims in check and reduce premiums.
Claims fraud happens when an employee tries to gain workers’ comp benefits by falsely stating that an injury or illness occurred at work or by exaggerating an existing injury or disease.
“Workers’ compensation fraud is a serious crime that can strain business operations, lead to higher insurance costs for businesses, and even undermine honest workers legitimately injured on the job,” said Ranney Pageler, vice president of fraud investigations at Employers Holdings.
The company found:
- 13% of small-business owners are concerned that one of their employees would commit workers’ comp fraud by faking an injury or illness to collect benefits.
- 21% are unsure of their ability to identify such fraud.
- 24% have installed surveillance cameras to monitor employees on the job.
The most vital indicators of potential claims fraud noted by survey respondents include:
- The employee had a history of claims (58%).
- There were no witnesses to the incident (52%).
- The employee did not promptly report the injury or illness (52%).
- The reported incident coincided with a change in employment status (51%).
What you can do
Pageler recommends that small-business owners look for the following warning signs:
- Monday morning (or start of shift) injury reports. The alleged injury occurs first thing Monday morning or late Friday afternoon but is reported on Monday.
- Employment changes. The reported accident occurs immediately before or after a strike, job termination, layoff, end of a big project, or the conclusion of seasonal work.
- Suspicious providers. The employee’s medical providers or legal consultants have a history of handling suspicious claims, or groups of claimants use the same doctors and lawyers.
- There are no witnesses to the accident, and the employee’s description does not logically support the cause of the injury.
- Conflicting descriptions. The worker’s accident description conflicts with the medical history or injury report.
- History of claims. The claimant has a history of suspicious or litigated claims.
- Refusal of treatment. The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
- Late reporting. The employee needs a reasonable explanation to report the claim.
- The allegedly disabled claimant is hard to reach at home and does not respond promptly to messages.
- Frequent changes. The claimant has a history of frequently changing physicians, addresses, or jobs.
It should be noted that one of these indicators alone may not indicate fraud, so don’t jump to conclusions.
If you suspect a worker may be committing claims fraud, you should first alert the special investigations unit or fraud unit within your insurance company’s claims department.
If the insurer deems that the claim may be fraudulent, the appropriate law enforcement authorities will likely be involved in the investigation. But that will only happen after the carrier has conducted its investigation.
BGES Group is one of New York, New Jersey, and Connecticut’s Construction Insurance Specialists representing 50+ companies, including all the BEST general & umbrella liability programs. We offer all the coverage needed, including property, builders’ risk, inland marine, general liability, umbrella liability, auto, bid & performance bonds, workers’ compensation, N.Y.S. disability, and group health. Our commitment to you goes beyond the policies we provide. We are always just a call, text, or email away, ready to assist you, even on weekends. We understand the importance of your business and are here to help you navigate any insurance challenges.
BGES Group are Workers’ Compensation Insurance Specialists for Tri-State Business Owners: Unhappy with your rates, company, being canceled, losses causing difficulty getting coverage, in the middle of an audit dispute, misclassified payrolls, or whatever your issue. We can help! We have special programs for Auto Services, Contractors (especially in New York), Limousine Services, Logistics Companies, Manufacturers, Recyclers, and Truckers; we can help ANY tri-state business owner. We are considered “Preferred Agents” for this one program that, if we can get you into, their pricing is excellent, offers long-term coverage stability, and can cover multi-state operations. The program takes the hassle out of doing annual audits, too.
If you want to speak with us, call Gary Wallach at 914-806-5853, click here to email, or visit our website.
Company: BGES Group, 216A Larchmont Acres West, Larchmont, NY 10538
email: bgesgroup@gmail.com
website: http://www.bgesgroup.com
© – Copyright – 2024 – BGES Group