Thursday, March 23rd, 2006

Monthly Newsletter

Volume 6 Issue 3 


Employers need safeguards to prevent workers' comp frauds

 

"The stories of workers' compensation fraud can be brazen, appalling or just plain stupid. Some schemes are concocted by hardened criminals, others by generally honest people who commit serious errors in judgment. But all are illegal, contributing to what appears to be a multi-billion dollar a year problem"

[Advisor Home]

 

 
Crutches used as props and wages deposited into an undisclosed bank account are evidence in real-life workers' compensation fraud cases...

The stories of workers' compensation fraud can be brazen, appalling or just plain stupid. Some schemes are concocted by hardened criminals, others by generally honest people who commit serious errors in judgment. But all are illegal, contributing to what appears to be a multi-billion dollar a year problem.

The American Insurance Association estimates workers' compensation fraud losses at $3 billion a year, while industry watchdog the National Insurance Crime Bureau puts it at $5 billion. Experts believe the difficulty with measuring fraud is that much of it goes undetected.

Crimes can range from "hard" fraud such as collecting benefits for faked injuries to "soft," which can mean exaggerating an injury or staying on benefits longer than necessary.

We estimate that 3 percent to 5 percent of our wage replacement claims have some element of fraud. Without an effort to recover them, the associated benefits would have totaled more than $2 million a year.

If you're an employer who is ready to turn a suspicious eye toward every workers' compensation claim that crosses your desk, don't. Most injury claims are legitimate. Instead, ramp up your fraud-prevention program.

  • Promote a fraud-free workplace. Convey your tough stance on fraud and let employees know how they can report fraud anonymously. Run background checks on employees before hiring. Install video equipment.
  • Consider drug testing. Drug users make unsafe workers and are more likely to file false claims.
  • Start a safety program. Safe workplaces make fake injuries harder to legitimize.
  • Have a plan. Put someone in charge of workplace injuries, recommend your medical provider right away, get an accident and injury description, preserve evidence and get names of witnesses.
  • Know the red flags of fraud: sketchy work history or "job jumper," child-support lien, extensive criminal record, exaggerated details about incident or symptoms.
  • Work with your insurer's investigative unit when you're suspicious.
  • Listen for rumors and scuttlebutt. Co-workers often know about after-work activities that may be inconsistent with injuries.
  • Prepare a return-to-work plan that includes temporary or alternative duties.

Claimants aren't the only drain on the workers' compensation system - employers and medical providers cheat, too. Premium fraud can be as simple as under-reporting payroll or misclassifying workers to a less risky category.

Medical provider double-dealings range from kickbacks from referrals to dozens of creative billing techniques like charging for services not rendered or billing for a more expensive one.

The truth is we all pay for insurance fraud. But it doesn't need to flourish. Every one of us, whether employer or employee, can do our part to stop it. Not only does every ill-begotten benefit dollar add cost to our system, it also serves to undermine the plight of legitimately injured workers who deserve every payment. Perhaps that is the worst crime of all.

(Article Taken from Maine Today)