A very small percentage of workers compensation claims are scams; most of them are legitimate. The most common type of workers compensation scams are faked injuries. If one of your employees collects workers compensation benefits for an injury they didn’t suffer, your company will pay the price. This is why it is very urgent that you know when an employee has faked their injury and when they are being genuine.
Example of a Faked Injury
Jane slipped and fell on some spilled liquid at the workplace. She has been away from work for several months because of an alleged leg injury.She claimed that her accident happened on Monday morning and on Tuesday she filed a workers compensation claim. Due to her leg injury, she has been receiving benefits for temporary total disability.
Two months into the accident and a workers compensation adjuster calls Jane’s boss and informs her that Jane has been pulling a workers compensation scam over her. The insurer had hired a private investigator who spotted Jane about a week after her accident going for an evening jog and she had no signs of a broken leg.
Jane is convicted of insurance fraud and is ordered to pay back the money she received as compensation for her injuries.
Some employees collaborate with medical providers to pull workers compensation scams. A crooked doctor can submit a claim for treatment he never provided. They can also decide to inflate the cost of medical care given or provide unnecessary medical treatment.
The doctor will then pay the employee kickbacks and instruct them on how to fake the injury. Other doctors collaborate with lawyers and employees to come up with elaborate plans to generate millions of dollars in fae workers compensation claims.
How this Will Affect Your Business
Workers compensation scams can affect your business in a number of ways. First, the worker with a faked injury isn’t working which means you might have to hire a temporary worker or pay other employees overtime to work extra shifts. Not only does this make the company less productive but it costs you more to hire extra employees or to pay employees overtime.
If your insurer adjusts your premiums depending on previous losses, then your company is likely to experience huge losses through fraudulent claims. The more the number of claims that your insurer has to pay, the higher your insurance premium will be.
How to Prevent Workers Compensation Scam
In order to prevent workers compensation scams, you use the tips below:
- Promote a warm and friendly environment in the workplace. The more the employees are happy, the less likely they will be to commit fraud.
- Always conduct a background check on potential employees to find out if they have ever been involved in a workers compensation scam in the past.
- Your workplace should always be safe. Ensure that you create a safe environment for your workers
- Have a return to-work program for employees who suffer injuries while at work.
How to Identify a Fake Injury
While it might not be possible to completely prevent insurance fraud at your workplace, you can help prevent losses by spotting fake injuries. Below are some tips that will help you identify fake injuries.
- The injury happened on a Monday or Friday or at the end of the day.
- No one witnessed the injury.They might claim that the accident happened when they were alone when usually they work with other employees.
- The employees story regarding what happened is inconsistent. The employee might tell the insurer a different story from the one they will tell the doctor about how they got injured. Also, their injuries might not match the type of accident they were involved in. For instance, an employee might say that a galvanized steel bar went through the windshield and pierced their shoulder when they got into a car accident while on their way to see a client using the company car. However, upon examination, the doctor finds that the wounds on the employees should are consistent with knife wounds.
- The employee delayed reporting the injury. They might report an injury that occurred over a year ago.
- The employee has behavioral issues or is unhappy. If an employee is dissatisfied with their job, they might fake an injury.
- The employee has filed several claims before. If they have filed claims before and every time they have received huge payments, then it could be a sign that they are trying to become rich at the expense of your company.
- The worker refuses to get a medical examination. The employee might insist they have a broken arm but will refuse an MRI which will confirm the injury.
- The worker is unreachable. They might not return emails, phone calls or text messages when you attempt to get in touch with them.
Call a Workers Compensation Lawyer in Plymouth, MA
Do you feel one of your employees has faked their injuries and is trying to commit workers compensation insurance fraud? Contact any one of our workers compensation lawyers in Plymouth today by calling 508-746-2700.