Use Unemployment or Discrimination Claims to Detect Fraudulent Work Comp Claims

If a fraudulent claim is suspected, the employer should ask persons assisting the employer to review additional records. Prior employers listed in the records may have vital information about unemployment claims, prior workers’ compensation claims or discrimination claims which have been filed by the employee.

If an employee has simultaneously filed a workers’ compensation claim and an unemployment or discrimination claim, the employer should review this information. The easiest way to deal with fraud is to show that the employee has made contradictory claims to other agencies for the same injury.

Here are two actual examples of fraud detected by obtaining the records of other claims:

Example 1
The employee has filed a claim for workers comp alleging work stress and harsh physical demands leading to chronic back pain. Three years later, the employer learned the employee had alleged discrimination and harassment in a civil rights complaint which was taken to the Appellate Division where the employer won.

The employee had alleged that she was a good worker who was performing her work but that co-workers harassed her by leaving a dead body outside her security station. This story was bizarre and incredible. It led to the employer winning both the discrimination and workers’ compensation claims but only because diligent investigation discovered the earlier discrimination claim.

Example 2
A foreign born worker filed for unemployment benefits alleging that he had been fired for being late after he had driven through a thunderstorm. He had testified in English at the hearing and there was no interpreter.

After he lost the unemployment claim, the employee filed a workers’ compensation claim alleging he had told the employer he injured his back but the employer did not understand him because the employee did not speak English. The persons assisting the employer on the compensation claim were not told of the unemployment claim for over a year. Fortunately, the records were obtained and the employee’s own statements were used to defeat the compensation claim.

Inconsistent Statements – Few persons filing fraudulent claims are consistent with their statements, especially when they are made to different administrative workers’ compensation claims and communicate with the workers’ compensation board, valuable information will be lost unless the employer alerts those charged with the defense of the workers’ compensation claim. This is an excellent example of how an employer can actively participate in the defense of their workers’ comp claims.

This information was provided by Attorney Theodore Ronca, P.O. Box 980, Aquebogue, NY 11931. Attorney Ronca handles workers’ compensation and disability claims on behalf of employers. Phone: 631-772-2100 or medsearch7@optonline.net

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Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.