Workers' Compensation fraud costs the State workers' compensation system millions of dollars each year.
Employers, employees, insurance carriers and consumers pay the cost of fraud in lost jobs and profit, lower wages and benefits, and higher costs for services and premiums.
Workers' compensation fraud can be committed by employees, employers, health care providers, attorneys and others. The amount assessed by the Department of Labor and Industries through administrative fraud orders, settlements, assessments and court orders in fiscal year 2000 was $30.4 million. The video surveillance SIA agents provide is powerful evidence. Our digital video recording equipment and techniques ensure high quality at great distances. See the proof on DVD, VHS, or any format of your choosing. While we can not reveal many of our covert techniques, our excellent audio and video surveillance evidence speaks for itself.
Investigations often lead to criminal prosecution and recovery of money.
Claimant fraud is the most talked about kind of fraud. It is also the type that employers are in the best position to help uncover. Claimant fraud happens when employees knowingly lie to collect benefits. They may claim an injury was work-related when it wasn't, exaggerate an injury, or secretly continue working while collecting benefits.
Red Flags for Workers' Compensation Fraud
There is no sure-fire way to identify fraud without proof, but there are red flags. Employers should call their carriers immediately if they identify two or more of these flags.
Disgruntled employee. The employee has a motive to fabricate the claim. Perhaps he or she was denied vacation time, demoted or fired.
Employee is hard to contact. The employee may be working another job while collecting benefits. This practice, called “double-dipping,” constitutes fraud.
New employee. Statistically, the newer the employee is, the more likely the claim is fraudulent, especially if other red flags appear.
No witnesses. Make note of alleged accidents with no witnesses, especially if the employee’s duties rarely call for him or her to work alone.
Varying accounts of accident. The injured worker may describe the accident differently to the employer and the doctor, or witnesses’ accounts may differ from the injured worker’s account.
Accidents on Fridays or Mondays. Accidents that occur on Fridays or Mondays should raise suspicion, especially if other red flags appear.
