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Workers Comp Insurance Fraud? Try This

Posted by David Ross on Sun, Sep 03, 2017

Tips for Investigating PA Workers Compensation Insurance FraudThe majority of workers’ compensation insurance claims are legitimate, and if an employee is injured on the job, they are entitled to the medical care and indemnity benefits stated in the workers’ compensation statutes. Unfortunately, there are also a number of fraudulent workers’ compensation claims every year.

Workers Compensation Insurance Fraud Statistics

The National Insurance Crime Bureau (NICB) estimates that workers’ compensation insurance fraud costs the insurance industry $7.5 billion every year, which in turn drives up the cost of workers’ compensation premiums. This doesn’t even take into account the cost of replacing the “injured” employee, training a new employee, overtime, and even a decrease in employee morale and productivity.

“Workers’ comp fraud is a large crime in America today,” according to the Coalition Against Fraud Insurance. “Scams are forcing premiums higher — draining business profits and costing honest workers their pay and jobs.”

Tips for Investigating Workers Comp Insurance Claims

Yet, many employers don’t investigate workers’ compensation claims properly. There is one simple thing every employer can and should do immediately following an accident or injury: collect written incident reports from the injured employee and any witnesses.

The injured employee should provide a written description of the incident including details of the accident, what caused the injury, the nature and scope of the injury, and what the employee thinks could be done to prevent the accident from happening again because.

Here’s why:

  1. Immediately following an incident, the employee should be able to recall the accident or injury more accurately than they could months or years later.

  2. Having the details of the accident in writing will discourage the employee from embellishing the details later, and having documentation of exactly which body parts were injured, limits the employee’s ability to add additional body parts to the claim at a later time. Tales do tend to grow taller on down the line.

  3. Often, if a claim is questionable, the adjuster will take a recorded statement from the employee. A written report allows them to compare the two reports to look for deviations. In this interview, the adjuster may also ask if the employee has any prior claims, accidents, and any prior injuries to the same body part.

Keeping the WC Claims Process Honest

The bottom line is that knowing that an employer has the details of the incident written in the employees’ own words goes a long way to help keep an injured employee honest.

Obtaining a written report from every witness immediately following the incident will help provide additional information about the accident and the extent of the injuries. Employers should be cautious of any accidents that have no witnesses or that the only witnesses are friends of the injured employee.

The employee’s supervisor or someone familiar with the work process should review the reports to confirm the accuracy of the information, and those reports should be given to the workers’ compensation adjuster. The employer should also provide information to the adjuster about any previous workers’ compensation claims, any other accidents or injuries the employee has incurred in the past, and any strenuous activities, sports, or hobbies the employee participates in.  

Create a Standard Protocol for Investigating Workers Comp Accidents

Having an established protocol for investigating accidents can help ensure that the proper steps are taken each time. It’s important that you react quickly to an accident or injury, capture the details quickly, and take the right actions to investigate the claim. Doing this will help limit the ability of dishonest employees to exploit legitimate workers’ compensation claims and help you keep workers’ compensation costs down.

How to Get the Best PA Workers Comp Insurance Coverage

Contact us for tips in preventing WC insurance fraud and for the best WC insurance protection in PA.To learn more about protecting your company against WC insurance fraud or your workers compensation insurance coverage options, you can reach us via our Contact Page or call American Insuring Group at (800) 947-1270 or (610) 775-3848.

Our independent agents are ready to help you get affordable insurance protection. We'll drive down your cost by comparing prices and coverages among lots of competing WC insurance carriers. Don't delay - contact us today and start saving!

Tags: WC Insurance, PA Workers Compensation Insurance, Workers Compensation Insurance, workers comp costs, workers comp insurance, workers comp