Most workers’ compensation claims stem from legitimate injuries sustained while in the workplace; however, there are some that are false. These can result in increased costs for all employers. CompSource Mutual’s Special Investigations Unit (SIU) successfully works with policyholders and the Oklahoma State Attorney General’s office to stop workers’ compensation fraud and prosecute violators.
Workers’ compensation fraud can occur in any business and any industry. Here are some red flags to look for:
- A new employee files a claim.
- An injured worker hires an attorney the day of the injury.
- The injury story changes often.
- There is a substantial delay from the time of injury to filing the claim.
- The claim coincides with a layoff or termination.
Workers’ compensation fraud is not limited to claimants; employers, medical professionals and attorneys can also be guilty of fraud.
Types of Fraud
An individual files a claim for an injury that does not exist, takes another job while receiving workers’ compensation benefits or makes misstatements to a doctor to obtain medical benefits
An employer misrepresents the nature, size, ownership or experience of their business in order to avoid paying the proper premium, understates payroll or misclassifies employees
A medical provider orders unnecessary tests and treatments or charges for services that were never performed
An attorney recruits clients and manufactures bogus workers’ compensation claims