Workers Comp


What is Workers Compensation Fraud?

Workers compensation fraud occurs when a claimant, employer, or health care provider knowingly lie in order to gain an advantage, savings, money, or other benefits. While many people believe that workers compensation fraud solely consists of employees lying about or exaggerating their injuries, workers compensation fraud can involve both employers and employees.

Notable Statistics

  • 1 in 4 Americans think it's okay to defraud insurers

  • $4.35 million dollars of insurance premium fraud was discovered in 2009

  • Between 2005 and 2009, $25 billion in disability payments were based on fraud

  • Workers compensation fraud costs the industry $5 billion annually

  • The average household pays $200-$300 extra per year in premiums to offset the cost of fraud

Employee Fraud

  • Injuries with no witnesses

  • Delays in reporting injuries

  • Delays in seeking medical treatment and/or missed appointments

  • Injury while off of work

  • Financial stress at home

  • Filing multiple claims

  • Injury concurrent with termination

Employee Fraud

  • Denial of valid claims

  • Late issuance of disability checks

  • Misclassification of the workforce and the nature of work being done by employees

  • Refusal to purchase insurance for employees

  • Making examples of employees who have submitted claims

  • Issuance of 'Ghost Policies' to independent contractors who are actually employees

What Techniques Do Investigators Use to Uncover Workers Compensation Fraud?

  • Surveillance - Investigators may use audio, video, and other types of surveillance to determine whether an individual worker is as injured as they claim.

  • Interviews and research - Workers compensation investigators may interview colleagues, friends, family, and other individuals to learn whether there is an issue of fraud and, if so, how great.

  • Background checks and records research - An investigation into worker's compensation fraud may include checking medical records, employment records, and other records. Private investigators may also run background checks to see whether a worker has filed numerous compensation claims in the past or if the company has a history of mis-classifying employees.

  • Evidence gathering - Workers compensation investigators can gather evidence if they uncover workers compensation insurance fraud. This can help employers and businesses prosecute fraud and cut off workers compensation claims that are not legitimate.