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Coalition Against Insurance Fraud
WORKERS COMP FRAUD
THE CRIME YOU PAY FOR
Watch out! You work hard to build your company — despite often daunting odds. And workers compensation insurance is critical to your success. It protects valued employees who are hurt on the job.
But widespread scams against workers comp are driving up your premiums, and often making affordable coverage harder to find.
Swindles rob billions from businesses every year. This threatens your profits, weakens your competitive edge, and harms your workers.
Protect what’s yours.
Make sure workers comp fraud doesn’t work at your company.
Build a strong partnership with loyal employees who are committed to your firm’s success. Encourage truthful claims by employees — and pay your own premiums honestly.
BOGUS CLAIMS
Most employees are honest, but even a few bogus claims can threaten your workers comp coverage — and business. Here are several common scams…
Off-job injuries. Injuries that happen at home or play are claimed as on-the-job.
Inflated injuries. Minor or phantom job injuries are inflated into big claims worth thousands of dollars.
Malingering. Workers stay home long after their injury heals.
Second job. Employees secretly take a second job while falsely claiming they’re disabled at your company.
Crooked clinics & lawyers. Dishonest medical clinics give needless treatment for inflated or phony job injuries. Shady lawyers encourage bogus claims and demand unreasonable settlements.
EMPLOYER FRAUD
Some business owners lie to reduce their workers comp premiums. They falsely report they have fewer employees or a smaller payroll than they really do. Or they lie that employees with higher-risk jobs actually work safer jobs.
Premium scams are a fast road to jail and large fines. They can even cost you your business. Dishonest competitors put you at a disadvantage because you subsidize their premiums.
RED FLAGS
Watch for red flags of possible bogus claims, such as…
- Claimed injuries happen Monday morning
- Worker is unhappy, and has a history of claims
- Employee is vague about accident details
- Injury happens in area where worker isn’t supposed to be
- No witnesses
- Injury happens just before worker leaves job or is disciplined
- Worker’s lawyer threatens to sue unless your insurer pays up fast
GET MAD, FIGHT BACK
Build partnerships. Create a safety program. Listen to employee complaints. Correct safety problems now. Show you care about good working conditions.
Zero tolerance. Inform employees that your company has zero tolerance for fraud. Scams cheat their company — and threaten their jobs.
Check candidates. Check job candidates closely. History of job hopping? No health coverage? Criminal background?
Report accidents. Require workers to report all job accidents immediately — and get them treatment promptly.
Alert insurer. Alert your insurer about suspicious claims right away. Encourage your insurer to investigate.
Provide procedures. Give employees written safety and anti-fraud policies & procedures.
THE PRICE YOU PAY
Workers comp fraud jeopardizes the business you’ve worked hard to build.
- Your premiums can rise dramatically
- You could lose your coverage
- Profits decrease
- Productivity declines
- Your business becomes less-competitive
- Customers pay more for your goods and services
- You may have to lay off employees or reduce pay
- You may have to close or move away.
Visit www.InsuranceFraud.org to learn more ways you can fight back.
