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Last Updated on: 18th October 2023, 09:02 am
Workers compensation fraud is when someone tries to get workers comp benefits they shouldn’t get. This article will explain what workers comp is, the different types of fraud, how people commit it, and what happens if you get caught.
Workers compensation, or workers comp, is a type of insurance that covers medical expenses and lost wages if you get hurt on the job or sick from work. It’s required in most states. Your employer pays the premiums. When you file a workers comp claim, the insurance company pays your medical bills and some of your salary while you recover .
The idea is to help people who get hurt at work without them having to sue their employer. Workers comp is the “exclusive remedy” meaning you can’t also sue your employer for damages. The tradeoff is you get your medical costs covered and some income while you’re out of work .
There are a few common types of workers comp fraud:
Let’s go over these in more detail:
This is when someone claims they got hurt on the job, but they didn’t really. Like pretending to slip and fall at work and file a workers comp claim. Or saying you got hurt lifting boxes, but you never lifted anything heavy.
Workers comp usually doesn’t require much proof of how the injury happened. So it can be tempting for people to fake accidents to get the benefits. Insurance companies watch for red flags like :
Sometimes people have a real but minor injury at work. But they exaggerate how bad it is to try and get more workers comp benefits. For example, maybe they strained their back moving furniture. They could claim severe pain and inability to work, even though it’s just a pulled muscle.
Doctors watch for signs of exaggerated injuries like :
People might claim an old injury happened recently at work. Like if they had a bad knee from sports years ago. They could pretend to fall and hurt their knee at work to file a workers comp claim.
Signs of an old injury claimed as new :
Malingering means dragging out recovery time on purpose to keep getting workers comp benefits. Say someone has a sprained wrist from work. It should heal in a few weeks. But they pretend it’s not getting better so they can keep collecting payments.
Doctors notice signs of malingering like :
Most states require you to report any income you earn while collecting workers comp. Some people work another job while collecting benefits but don’t report it. That’s considered fraud.
Investigators look for :
There are a few common ways people try to pull off workers comp fraud:
Having a witness helps prove a workplace accident happened. So people committing fraud might get friends or coworkers to lie and say they saw the accident.
Investigators look for :
Some doctors defraud workers comp by exaggerating injuries for profit. They might diagnose fake conditions, perform unnecessary tests and procedures, or prolong treatment.
Signs of a fake doctor :
Lying is common in workers comp fraud. People may lie about:
Investigators look for inconsistencies and evidence that contradicts claims.
The penalties for workers comp fraud depend on the state. But all states take it seriously. Some potential consequences are :
Some key defenses to fight workers comp fraud charges are :
But it’s very hard to beat fraud charges once you’re accused. It’s not worth the risk trying to cheat the system. Be honest upfront and focus on getting better.
Workers comp fraud hurts employers, insurers, taxpayers, and honest employees. Some people think of it as easy money. But it can ruin your career, finances, and reputation if you get caught. It’s better to prevent fraud by reporting suspicions and following the rules.
If you’re injured at work, be upfront with doctors, investigators, and your employer. Getting better should be your only focus. With honesty and patience, the system is designed to cover your medical treatment and lost wages so you can heal.
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