BGES Insurance Fraud

What Every Business Should Know About Workers’ Comp Fraud

BGES Insurance Fraud

If employees are hurt on the job, workers’ compensation coverage will protect them. This coverage pays for lost wages, medical bills and any other related expenses workers incur while recovering. Since the number of scams with this type of insurance are very small, it is safe to assume that the majority of employees are honest about getting hurt. Another incentive for this is the requirement that a doctor must provide an assessment. If an employee were not really hurt, a doctor may be able to identify a false claim. However, some scam artists slip through the cracks, and the damage they cause is substantial enough that it costs billions of dollars every year. In addition to this, some employers skip paying premiums. Both offenses are considered workers’ comp fraud.

Although the scam rate is lower for workers’ comp than it is in other areas of insurance, the perpetrators are causing premiums to increase for everyone. This is costly for honest workers and businesses alike. When dishonest employees make bogus claims about injuries, their motives vary. One of the most common motives is free money. In most cases, the workers claiming to be injured have other jobs or secret businesses they use for additional income. Another motive is free vacation time. Many workers want to collect money and have time off to enjoy traveling, hobbies or other activities.

How Bogus Claims Work

There are several different ways workers can make claims and get away with their lies. The following paragraphs outline some of the most popular methods they use.

Exaggerated Injuries

If a worker is using this method, he or she will have a very minor injury. It may be a slight pain in the back, wrist or any other location. However, he or she will embellish the injury’s severity enough to take time off of work. After taking time off, the worker will usually claim that it is taking a long time to recover in order to collect more money.

Off-Site Injuries

People who get hurt while they are off the job may wait until they return to work to file a claim. They may fake an incident that would result in the same injury they sustained while away from work.

Fake Injuries

In some cases, workers may fabricate the details of a nonexistent injury. Some of the most popular scams involve soft-tissue damage. Back and neck problems are common claims. Since some of these are hard to disprove, employers may have to pick up the tab for a such a worker’s dishonesty.

While these are the most common methods used, some workers may use an old injury or malingering to gain money. With old injuries, workers pretend the damage is new in order to get out of work or to get paid for treating injuries they may not be able to afford to treat otherwise. Malingering is abusing the system by staying home longer than necessary.

Stolen Premiums

In some cases, workers’ comp fraud is committed by business owners who reduce the premiums they owe. Such premium scams may be hard to detect. If businesses use this method, they often hide their swindles behind covers, tax records, dummy companies or fake accounting records. Although the number of bogus claims made each year exceeds the number of premium scams, the scams have a much larger financial impact. One scam alone can cost hundreds of thousands of dollars. If a scam lasts for several years, the total may reach into the millions.

Whether businesses are avoiding paying premiums, lying about the number of workers on the payroll or lying about workplace safety, workers comp fraud is a serious offense. Lying claimants and crooked doctors also face serious consequences if they are caught. Employers can fight back by being insured properly, making the workplace safer and making the environment at work a happy place for employees. To learn more about this type of fraud and how to prevent it, discuss concerns with Gary Wallach 914-806-5853.

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