The Problem Of Workers Compensation Insurance FraudIt's estimated that workers compensation insurance fraud is one of the fastest growing problems in the insurance industry. There are many different ways to commit this type of fraud and it seems as though not only employees, but employers as well as medical professionals are taking part in these scams. It can be difficult to detect, but if an individual is caught participating in a workers compensation insurance scam, they face very serious consequences.
Arguably the most common of this type of insurance fraud involves employees. When someone gets hurt on the job they are entitled to employee compensation from workers compensation. The process is relatively simple in that the employee fills out a claim form, is then seen by a doctor and may speak to a representative from the workers compensation board. If the employee's injury is serious enough to prevent them from working, they are often sent for additional tests as well as therapy. When an employee decides to start a fraudulent claim with a company it typically begins before the injury even occurs. The employee will try and position themselves in a spot where they realize they are likely to get hurt. In some cases, a real injury will occur, while in others, the injury isn't real. The employee will certainly act as though they are in terrible pain and will then have to seek medical help. This is where a doctor typically becomes involves. If the doctor is part of the insurance fraud case, he or she will exaggerate the individual's injury on the documentation. The doctor may also indicate that tests or procedures were performed that never were. The doctor collects their fee from the workers compensation board. They can require as many appointments as they like with the patient, as the workers compensation board does insist on regular medical treatment. In many cases like this, the employee is only required to see their attending physician. This is one of the biggest problems with workers compensation insurance fraud in that the employee could have an arrangement in place with the doctor in which the doctor is receiving a portion of the benefits for ensuring the documents are filled out to reflect a serious injury. Typically if the workers compensation board believes that fraud may be taking place they will launch an investigation. This investigation is likely going to require that the employee visit another physician, one that is assigned by the workers compensation board. If the patient has been feigning an injury all along, it will surely be realized at this point. Employers contribute a fair amount to the workers compensation board each year in order to protect their employees. When employees cheat the system in these ways, it cost employers more. |