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Workers' Compensation And Insurance Fraud



Workers' compensation benefits provide financial and medical benefits to individuals who have been injured as a result of a workplace incident. The goal of the workers' compensation system is to provide injured workers with financial and medical benefits during the time necessary for treatment and recovery from an on-the-job injury or illness.

What Is Workers' Compensation Insurance Fraud?

Fraudulent workers' compensation claims have increased in the United States, largely due to the weak job market, reduction in unemployment benefits and the overall economic situation. The majority of workers' compensation claims are filed by honest people who have suffered a credible on-the-job injury. Nationwide investigative studies have found that only approximately two percent of workers' compensation claims are fraudulent. Unfortunately, the payment of fraudulent claims increases premiums paid by employers and places undue scrutiny on injured workers. Proposed changes in workers' compensation laws are designed to expedite the benefits claims process and minimize fraudulent claims.

Workers' compensation insurance fraud can be perpetuated in several ways:

  • An injured worker may report an on-the-job injury that happened elsewhere.
  • A worker may exaggerate the injury.
  • A worker may be malingering to avoid returning to work.
  • Dishonest healthcare clinics may exaggerate the seriousness of injuries to justify the over-billing of insurance companies.

Will My Claim Be Investigated?

Workers' compensation claims are subject to random credibility evaluations. Fraud investigations typically occur if a worker has filed numerous claims within a short period of time or if several claims have been filed against the same employer. Many workers' compensation carriers conduct initial assessments before accepting a claim. Your medical and employment records will be reviewed as part of the claims processing procedure. A representative from the insurance company may attempt to interview you about the facts surrounding your injury and the medical treatment you have received. You may be asked to undergo an independent medical examination to verify the nature and severity of your injury. As independent medical examinations are paid by the insurance carrier, the results may not be in your favor. Do not participate in an interview or a medical examination without the approval of your workers' compensation lawyer. Workers' compensation is generally the first step in obtaining financial and medical assistance following a work-related injury. Your lawyer can help you apply for additional programs, such as short or long term disability insurance through your employer or social security disability benefits.

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