Communicating Fraud Control Is Critical to Workers Comp Management

A Message Employers Can Send Employees When communicating  with employees make it clear the company  immediately  investigates each accident when it occurs to determine the root cause and to identify corrective measures.  And, will be on the alert for both minor extensions of days out of work and outright fraudulent claims.  (From:  Workers' Comp Kit Blog, April 2009. Review  the 25 "Red Flags" of Fraud on our blog). What Happens When Fraud is Committed?  Is It Worth It?* Two More Cases Case Three: As an employee of a paint company filed a claim for benefits, saying he injured his back, left shoulder and knee after falling from a ladder.  The claimant testified under oath at a workers' compensation board hearing he had not worked anywhere since the date of his accident. He also submitted signed statements stating he had not returned to any form of work. An investigation,  conducted by the states fraud department and WC board fraud inspector found one month after his accident he was observed working at a house on a painting job for the home owner paid him $1,400.  The claimant received more than $13,000 in workers' compensation benefits during the period he claimed he was unable to work. Now in prison  on unrelated charges he may have painted himself into a tight corner as he was charged with committing fraud against the states insurance fund for allegedly lying about his ability to work in at workers' compensation hearing. He faces felony charges of offering a false instrument for filing, insurance fraud, grand larceny, violating workers' compensation law and perjury. Case Four: A fish salesman  received more than $60,000 in workers' compensation benefits allegedly while running his own business. An investigation,  found the defendant was allegedly self-employed as the owner of a fish farm while receiving benefits totaling $66,100 for a work-related back injury.  Investigators found the defendant signed documents stating he had not returned to work during the time of his claim. He faces felony  charges of violating the workers' compensation law, fraudulent practices and offering a false instrument for filing. *Extracted from original cases.  Names and places omitted for privacy.  These cases are a generic representation of what happens when fraud is committed in workers' compensation claims. Author:  Dave Thomas is editor of Daily Insurer Blog.  Dave has kindly granted us permission to make use of information from his blog site pertaining to worker's compensation issues.  Visit him at http://dailyinsurer.blogspot.com/ for more information on the articles appearing here. Click on these links to try it for yourself. WC Calculator www.ReduceYourWorkersComp.com/calculator.php TD Calculator www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101 www.ReduceYourWorkersComp.com/workers_comp.php 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. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com