Multiple Body Parts Claims – How Fraudsters Are Abusing California’s Workers’ Comp Laws

California workers’ compensation claims involving multiple body parts is on the rise, according to a recent Los Angeles Times data analysis report.

The report showed that claims involving five or more body parts – which, up until the mid-2000s, has been the least common – have now become the most common in the state of California.

This development was a response to workers’ comp reforms introduced by then-Gov. Arnold Schwarzenegger in 2004, that lowered the amount of money to be paid out in benefits for individual body parts.

The official replaced California’s generous compensation system with one closer to the national standard, dropping both the number of injured workers qualified for payouts and the amount of money those that qualified did receive per body part.

This was partly because of the former Governor’s experience training as a bodybuilder in Venice. He said that many people able to train twice a day could afford to simply because they were on workers’ comp, a fact that reportedly angered Schwarzenegger.

The data – and interviews with lawyers working around the issue – revealed that claimants simply beat the system by increasing the number of injured body parts per claim.

A chart prepared by the LA Times showed that from 1996 to 2004, only about 10% of claims involved five or more body parts. The most common back then were claims of injuries to just one body part, which accounted for 40-50% of all claims.

But after 2004, claims of one injured body part began to drop and claims of injuries to 5+ body parts rose dramatically, eventually becoming the most common of claims by 2009.

In 2018, claims of injuries to five or more body parts account for about 30% of all claims, with some claims involving over 10 parts. Despite that, the report also detailed several cases, many of them in law enforcement, of claimants being caught doing strenuous activities like scuba diving.

For any help handling medical claims fraud, get in touch with TukkoMed  for a consultation on how early detection reports or other services can help your company.