Every state battles fraud and abuse of its Workers Compensation system. Even though you use Worker Comp to protect your employees and keep your premises safe, you might well end up paying higher premiums because other firms, employees, and medical providers have no compunction about cheating the system through fraud and abuse.
Workers Comp fraud involves such criminal acts as workers falsifying claims, employers misclassifying high-risk workers with less dangerous jobs to lower their premiums, and physicians exaggerating injuries and their treatment and overbilling insurance companies for expensive services never rendered. Fraud has led a number of states to pass legislation simplifying the prosecution of offenders. On the judicial front, some states provide insurance companies with immunity from lawsuits if they report Workers Comp violators. On the downside, insurers need to tread cautiously because a firm wrongfully accused of fraud has legal recourse after a false report or misleading statement.
Unlike fraud, Workers Comp abuse isn’t a felony, although it also increases premiums for everybody. Usually, this misuse of benefits involves a worker who uses unnecessary medical services, remains away from work after their injury has healed, or reports an off-hours injury as happening on the job.
According to a recent Insurance Research Council survey, more than one in four workers (28%) believe that padding Comp claims is justified to recover the policy premium, which they aren’t even responsible for paying! Insurance companies have trouble detecting this common abuse, especially when they’re up against a stress or soft-tissue injury, because there are few if any physical symptoms. This attitude among workers might be an extension of the belief that claims-padding on policyholders’ Personal insurance coverages (Auto or Homeowners) is simply a way of getting their money’s worth from their premium.
As a business owner or manager, you can help curb Workers Comp fraud and abuse and keep your premiums under control by:
- Screening out potential abuses when you recruit employees and assign jobs.
- Developing close, mutually respectful relationships with your workers to minimize any grudges against management that might encourage abuse.
- Keeping close tabs on potential abuses of the system.
We’d be happy to work with you in reaching these goals. Just give us a call.
