Workers' Compensation Fraud

Signs of Workers’ Compensation Claims Fraud

Every year, billions of dollars are illegally claimed by those who take advantage of workers’ compensation fraud. According to the National Insurance Crime Bureau, more than $5 billion is taken by people who either fake an injury or exaggerate one in order to get a break on their insurance and money in their pocket. And while injuries on the job do happen and most claims are legitimate, it’s safe to say that a small amount of fraudsters are making a big impact.

Because of this fact, it’s important for every industry, such as Staffing agencies, to be aware of the signs of workers’ compensation fraud and know what to do when fraud is detected.

What is Workers’ Compensation Fraud?

Workers’ compensation fraud occurs when someone makes a false claim about an alleged injury on the job or conceals information in order to receive workers’ compensation insurance benefits. This can happen for a number of reasons, including having sustained injuries on their personal time.

How to Reduce Workers’ Comp Fraud

Here are some things to look out for when wanting to cut down on workers’ compensation fraud claims:

  • Delay in Reporting: Employees who are actually hurt on the job will more than likely report it to the correct contact right away. While some injuries may cause them to not be able to do so, a significant delay can be a major sign that the claim might be something that might not have happened on the job.
  • Monday Mornings: No one is a fan of Monday mornings, but to fraudsters, Mondays make for the best day to report false claims. If someone claims an injury on a Friday and waits until Monday to make a claim, there may be something untoward happening. This could be the sign of something that occurred over the weekend.
  • Outlandish Details: Most legitimate claims can be supported by specific details of an injury. If the story ends up changing over time or if answers are vague, it could be a major warning sign that something isn’t quite right.
  • History of Claims: If a person has had a suspicious history of making litigated workers’ comp claims, it may be a sign that they have been trying to game the system for some time.
  • Hard to Reach: Claimants who are legitimately hurt are usually easy to get a hold of, especially when it comes to nailing down what they need to do next and what they can expect as far as benefits. If someone is avoiding calls, it may be a major red flag that they’re avoiding insurance carriers for a reason.

Other Measures to Minimize Fraud

Staffing agencies can proactively cut down on the potential for false workers’ compensation claims. One way to do this is to establish a zero-tolerance policy when it comes to fraud and communicate these guidelines with employees through anti-fraud policies.

Staffing agencies should also consider creating a work culture where employees do not feel they will be retaliated against if they make a claim. This can be accomplished by establishing a number of safe and anonymous ways for employees to report suspicious activities. By promoting a culture of safety and transparency, staffing agencies can help to cut down on potential workers’ compensation fraud.

Monarch Partners Group Has Vast Experience with Workers Compensation Fraud

For more than 30 years, Monarch Partners Group (MPG) and affiliate Nationwide Employer Services LLC have focused on providing Workers’ Compensation insurance solutions for distressed risks and industries. Our long-term history and expertise in the space and market sources enable us to find solutions for business owners and brokers that they may otherwise not have access to. We write Workers’ Compensation coverage for all types of risks in all states with solutions that Employer Organization (PEO), Employer Of Record (EOR) and Captive Insurance programs. To learn more about our products and services, contact us today at (855) 435-5153.