Workplace injury and illness risks vary from industry to industry, the worksite, and the workplace. While accounting departments face their own set of workplace injury risks, they differ in size and scope compared to, say, the construction industry. However, regardless of the industry, all are just as susceptible to workers’ compensation fraud. Based on data from the National Insurance Crime Bureau, workers’ comp fraud costs businesses in the United States about $30 billion annually. Companies can better understand common workers’ compensation fraud examples to protect against workers’ compensation fraud and limit the financial fallout.
Personal Time Fraud
Known in the field as “Weekend Warrior fraud,” this occurs when someone injures themselves on the weekend or on their personal time, only to claim they got the injury or illness while at work. To validate the details of any injury at work, companies need to complete thorough incident investigations, going over everything from how the injury happened to contacting potential witnesses who can validate the claim. Businesses need to ask plenty of questions as soon as the report comes in (usually on Mondays) and document all details in a report.
This happens when a worker collects temporary disability benefits while also continuing to work and earn a paycheck. Usually, this paycheck comes from outside the business filing the workers’ compensation claim. This kind of fraud can be harmful to a company in many ways, including an employee defying their doctor’s orders to stay home until they can safely return. The worker can end up overexerting themselves and end up making their injury even worse.
If an employee suffers an injury on the job, it’s the business owner’s job to ensure they have the best return to work program available. Reports need to be received from every doctor’s visit as any update on the employee’s status can help determine when they can return to work properly.
Medical Provider Fraud
Workers’ compensation fraud can also occur when the medical providers get involved. In some situations, corrupt medical providers may inflate medical bills or even make them up entirely, hoping the workers’ compensation insurance provider will take care of the overall cost.
Exaggerating the Injury
Another common workers’ compensation fraud example is when an employee lies about the existence of a work-related injury or illness or exaggerates the severity of the problem. This happens when an employee claims something like a back injury is so severe, they cannot get out of bed. However, they have recently posted pictures of themselves on social media after their supposed injury engaging in sports or travel activities. Employees found guilty of this fraud can face criminal charges, fines, and penalties, including repaying the insurance company for the benefits received.
Fraudulent Insurance Certificates
An insurance certificate proves a business has insurance in place, such as a workers’ compensation policy. If a business hires subcontractors, it’s likely to be familiar with requesting and documenting certificates of insurance for the subcontractors. If someone is injured on the job and they or their employer don’t have the right workers’ compensation policy, they could end up noted as a full-time employee of the business who hired them out for a job.
When working with subcontractors, it’s essential to do your due diligence before any work begins. Start by requesting a copy of their certificate of insurance, then verify it with their insurance carrier. This can help mitigate the potential for insurance fraud.
About InsureMyWorkComp & Their Workers Comp Solutions
InsureMyWorkComp is a digital brokerage that helps clients find the right workers’ compensation solution for their business needs, such as occupational accident insurance. Unlike other online platforms, we will help you to work with an agent who can provide you the right solution for your risk profile. Our staff has over 50 years of workers’ compensation underwriting and sales experience, and we are confident that we will provide you the support that you need. For more information or to get a quote, contact us today at (855) 340-9138.