Fraud Detection & Prevention

How to Avoid Workers’ Compensation Fraud

Workers’ compensation fraud steals $80 billion1 nationally from the insurance industry and its policyholders every year. While very few workers’ compensation claims are fraudulent, the expense can have a considerable impact on a business’ insurance premiums.

We aggressively identify and investigate red-flag concerns, and when legitimate situations do occur, we are vigilant about pursuing and resolving the matter as quickly as possible. Working closely with our customers is an important part of detecting and preventing workers’ compensation fraud, and there are several important steps you should always follow to minimize fraudulent claims.

These steps include:

  • Verification of references and work history upon hire
  • Immediate reporting of all claims
  • Reporting of suspicious activity or claims concerns to our Fraud Hotline – 800-944-3728

Examples of Workers’ Comp Fraud

  • Falsely reporting payroll figures to reduce premium
  • A claim made for an injury sustained someplace other than at work
  • An employee collecting wage payments while working at another job
  • Physicians billing for services not rendered

Workers’ Comp Fraud Warning Signs

  • Claims reported first thing in the morning, especially on Mondays or just after lunch
  • Claims in which the details surrounding the incident change over time
  • A medical bill that reflects services not rendered
  • An injury sustained in a highly populated work area, but without any witnesses

How to Report Fraud

If you or an employee suspect workers’ compensation fraud, call our anonymous hotline at 800-944-3728. All calls are strictly confidential.

1 Source: Coalition Against Insurance Fraud