Workers' Compensation Fraud - The Untold Story

Although it may not seem that you are in danger of suffering an injury in the workplace, the reality is that even a seemingly safe occupational environment can be the site of an accident that requires you to seek medical attention. Fortunately, most states require that the majority of employers carry workers' compensation insurance to cover the cost of medical care and other considerations associated with an occupational illness or injury. These laws do not require an injured worker to demonstrate that his or her employer was at fault, but even so it is possible for an employer or insurance company to engage in workers' compensation fraud.

This issue can become very confusing because the reports about workers' compensation fraud are typically made from the vantage point of the insurance companies and employers who are seeking to cast doubt on the genuineness of occupational injuries. While it is true that there are some people who would seek to abuse the system, the vast majority of persons who file claims for workers' compensation benefits are legitimately hurt and in need of assistance to address the costs and financial losses incurred by an on the job accident.

Examples of Workers' Compensation Fraud

A single employee who attempts to file a fraudulent claim does not stand to gain financially. He or she will receive less income than under normal work circumstances. Employers and workers' compensation insurance companies, however, have a multitude of reasons to engage in this deceptive practice. The profitability of insurance companies, for example, depends upon taking in as much money as possible through premiums and issuing only minimum benefit payments. As a result they will aggressively look for any opportunity to deny a claim or to reduce their liability. Employers, on the other hand, might be saddled with higher premiums if their workers file claims.

Because there is so little open discussion about the fraudulent actions perpetrated by employers and workers' compensation insurance companies, it may not be obvious which deed could constitute such a violation. The following are some representative examples of workers' compensation fraud:

• Failure to carry the insurance coverage required by state and federal law
• Intentionally misrepresenting an employee's date of hire or other information
• Denial of benefits without cause
• Allowing bribes to influence the assignment of healthcare providers
• Delayed payment of benefits

Where Should You Turn