Insurance fraud costs everyone, including employers, employees, providers of goods and services, and insurance companies. Learn more about workers' compensation fraud and how we can work together to prevent fraud.
Top 10 Ways to Reduce Fraud
- Educate your employees about workers' compensation fraud and its consequences. Reinforce that workers are the real victims of fraud. If your premiums are high, you can’t afford raises, bonuses, and other incentives.
- After an accident where an injury occurs, refer the employee to your designated physician. Avoid “doctor shopping” by using a WCF Insurance preferred provider who understands workers' compensation injuries.
- Interview the injured employee for accident details.
- Interview witnesses and get written statements. Pay attention to what other employees say to each other about the accident.
- Investigate the scene for facts that corroborate or contradict the employee’s account of the accident.
- Enforce drug testing. It's important to have a policy in place that requires screening after an accident.
- Watch for the red flags of possible fraud. Stay in close contact with your injured employee. Contact makes an employee feel valuable and promotes an early return to work.
- Implement modified duty when possible. Bringing an employee back to work can reduce costs and increase communication.
- Fill out the Employer’s First Report of Injury form in detail, even if it requires an extra page.
- Report any concerns to your adjuster as soon as possible. With early intervention, you can document information that may be lost, forgotten, or concealed later.
Workers' Compensation Fraud Red Flags
Employee Red Flags
- Is seldom available at home
- Delays returning to work after maximum medical improvement
- Refuses light duty opportunities
- Is vague or contradictory about how the injury occurred
- Was in jeopardy of termination or probation before the injury
- Shops for a provider or is noncompliant with treatment
- Delays reporting the injury
- Evidence that employee has other concealed employment
- Participates in activities contradictory to reported physical limitations
- There is no witness to the injury or resulting symptoms
Employer Red Flags
- Fabricates location or type of operation
- Under reports payroll
Physician Red Flags
- Bills for services not actually rendered
- Bills for products not actually provided
- Fabricates procedures
- Unbundles services