Legitimate Workers Compensation

Workplace injury and illness risks differ depending on the company and industry. While accounting firms aren’t usually exposed to extreme workplace hazards, common employee injuries such as slips, trips and falls, back injuries and repetitive stress injuries sometimes occur. Any time an employee gets hurt, there is the potential for workers’ compensation insurance fraud to occur.

According to the National Insurance Crime Bureau, workers’ compensation insurance fraud is a serious crime that costs businesses $30 billion annually.[1] One common type of fraud is claim-related fraud, which is when an employee attempts to gain a workers’ compensation insurance benefit by falsely stating an injury or illness occurred at work or by exaggerating an existing injury or illness.Committing this type of fraud may lead to higher insurance premiums for employers and may ultimately hurt workers who are legitimately injured on the job.

Insurance Policy for Rent

Some employers are creative, finding new ways to commit workers’ compensation fraud. A Florida woman “rented out” her policy to others.

The woman created a shell company for which she purchased a workers’ compensation policy. She told her insurer that she had worked in construction for ten years and employed five workers. In reality, she had never worked in the construction industry and employed no one.

Foiled by Facebook

 

If you file a false workers’ compensation claim, don’t broadcast your misdeed on social media. ​An Ohio woman learned this lesson the hard way. She had filed a claim alleging that she was injured in a slip and fall incident in a company parking lot. In a Facebook post, however, she stated that the fall occurred at a nearby gas station. The Ohio Bureau of Workers’ Compensation learned about the post. The woman was ordered to pay a fine and to return all the benefits she had received.

Self-Enrichment Through Self-Insurance

 

Employers, employees, and providers aren’t the only people who commit workers’ compensation fraud. A county in Pennsylvania lost almost $650, 000 due to the acts of a corrupt third-party claims administrator.

Two partners owned a claims administration business. The company was hired to administer a workers’ compensation self-insurance fund operated by Lackawanna County. As the fund administrator, the firm was supposed to review bills from providers, pay claims, and issue various reports. Instead, the partners spent their work days smoking cigars and watching porn on the Internet.

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