If you are an American citizen working in the United States, then you are backed by what is known as Workers’ Compensation – a system that dispenses benefits to people injured during the performance of their jobs. Millions all over the country make use of the system to receive their rightful compensation for a legitimate workplace injury. Unfortunately, and just like in any other system, there are those looking to take advantage of these benefits even when they do not legally qualify for them. Below is a list of five of the most common types of workers’ comp fraud to watch out for in the USA:

  • Injury Fakers – Injury Fakers are people that attempt to file workers’ comp claims despite never being injured in the first place. As ridiculous as it may sound, there are many dishonest employees all over the country that attempt such a thing. Therefore, it is important for companies to mount an exhaustive medical examination of the claimant – to ensure that the injuries claimed actually do exist.
  • Injury Exaggerators – As opposed to fakers, these people have sustained some kind of injury but have chosen to exaggerate the severity of said injury in order to claim more benefits than they deserve. Again, a medical evaluation should be able to identify the type and severity of any injury – so companies must continue to rely on doctors to reveal the extent of an employee’s injuries.
  • Injury Opportunists – Injury Opportunists are people that sustained an injury outside of the workplace, but then attempt to claim benefits by lying and saying that their injuries were sustained while at work. These can be tricky to handle as it may be difficult to identify exactly when an injury happened, but it helps to have systems in place that accurately record when and where the claimant was working.
  • Dishonest Employers – While most kinds of fraud are employees targeting business owners with exaggerations and outright lies about sustained injuries, employers have a few tricks up their sleeves as well. By misclassifying employees as “independent contractors”, employers can avoid paying for workers’ compensation benefits altogether. These issues are often identified, investigated, and acted upon by the state and, if accused, the offending parties may be forced to pay fines and even spend time in jail.
  • Medical Bill Inflators – Another source of workers’ comp fraud are the doctors charged with providing medical services for injured claimants. Though most doctors are trustworthy individuals, there will always be a few that ruin it for everyone. Dishonest doctors aim to inflate medical bills by either performing unnecessary services or adding charges for services that were never even performed to collect more money. In this case, it is usually insurance companies that stand to lose out on inflated medical payments – which is why they also must be extremely careful with every claim that passes through their hands.

TukkoMed has got the lowdown on Workers’ Comp news and updates. Stay afloat by checking back on a weekly basis – and if you are a QME that needs assistance managing your reportorial tasks, get in touch with us today to find out how we can help you breathe easier.

Write a comment:

You must be logged in to post a comment.

2014 © Copyright - by TukkoMed

Contact Us! info@tukkomed.com