Workers Comp Fraud: Identifying and Preventing Scams

Posted on: August 5, 2015 by Javier iSure

While the majority of workers’ compensation claims are valid and deserve immediate reconciliation, the many employers are susceptible to workers’ compensation fraud. Although there are a variety of fraudulent claims, these are the most common forms of Miami Workers’ Compensation Insurance fraud types.

Abusers- These fraudulent claims are typically submitted by employees who were not actually injured at work. Rather, their injury was suffered elsewhere but they still seek claim benefits from your company. Warnings for these type of claims can be determined by identifying how many claims the individual has filed with your company and others.

Opportunists- While these employees are injured on the job, they attempt to take advantage of the system to collect more benefits than they deserve. For example, they seek more compensation, draw out the claim for long periods of time, exaggerate their symptoms, stall appointments, and are uncooperative with treatment plans, as mentioned by Property Casualty 360.

Forgotten Employees- These employees were injured on the job and have legitimate claims. While they had no intention of committing fraud, certain circumstances can lead to retaliation on the employee’s behalf. For example, if their claims have been put off, their job has been replaced, or they are suffering from depression caused by lack of healing, the employee might feel more inclined to forge their circumstances.

In order to combat workers’ compensation fraud, there are a few steps that employers should take. First, be sure that you have a set process in place to manage the claims efficiently and effectively. Training employees and supervisors on proper procedures is essential to reducing the risk of injury on the job, as well. Further, employee should be made aware that their recoveries are a priority; encouraging open communication is critical to lessening your workers’ comp claims.

In the event of a claim, workers should be expected to do the following:

-Report injury immediately.

-Identify referral requirements and find an objective healthcare provider.

-Attend appointments without delay and follow up with progress.

-Perform work duties that are parallel with physical capability

At iSure Insurance Brokers, we aim to protect the backbone of your business: your employees. As workers’ compensation is a necessary component to your company, we aim to protect your investment with comprehensive coverage for a variety of risk exposures. For more information on our products and services, contact us today at (855) 381-6123.

Posted in: Blog Healthcare Insurance Workers' Compensation