Security cameras in a company cafeteria recently captured a brazen attempt to fake a workers’ compensation injury.
The video shows that the man dumped a cup of ice onto the floor, disposed of the cup and then lay down on the floor as though he slipped on the ice. Prosecutors have charged the man with insurance fraud and theft by deception.
In this case, the fraud was well documented. Most employers do not have cameras in their lunchrooms or other areas of their workplaces. It can be very difficult to prove someone has faked an injury in the workplace without cameras catching him in the act.
But the consequences of undetected workers’ compensation fraud are enormous. Fraud is a costly financial burden to employers and taxpayers, and it interferes with providing benefits to the vast majority of injured workers with legitimate claims.
If an employer suspects an employee has attempted to create a fake injury or fraudulent claim, there are several steps to follow up on right away:
Faked injuries may also be an indication of fraud perpetrated by dishonest medical providers or attorneys who operate “claim mills.” These fraud schemes recruit workers to submit fraudulent claims, can generate millions of dollars of undeserved benefits and impact employer loss experience resulting in higher workers’ compensation premiums.
It’s important that claimants understand that their participation in reporting fraudulent claims exposes them to prosecution and severe penalties.
Here are several red flags that could be indications of a faked workers’ compensation injury:
Employers who suspect a faked occupational injury, or other workers’ compensation fraud or abuse, should seek assistance from their insurer or claims administrator. Potentially fraudulent claims are referred to the Special Investigation Unit (SIU), and cases with enough evidence are sent to the District Attorney for prosecution.
Stacey Gunn is assistant vice president of the SIU/Fraud Unit for Keenan and Associates' public agency property and casualty practice in Torrance, California. This entry is republished from Keenan's blog.
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