What Is An Example Of Workers Comp Insurance Fraud ─ 5 Common Cases

When it comes to insurance fraud, workers’ compensation insurance fraud can be one of the most damaging and costly for employers.

So what is it exactly? It’s when an individual or group deliberately misrepresents facts or information related to a claim to receive benefits to which they would not usually be entitled.

Here are some common examples of workers comp insurance fraud in the workplace.

1. Personal Time Fraud

Personal time insurance fraud is when employees report a workplace injury or illness outside or during time off from work. This type of fraud is often attempted by employees who have already used up all their sick days but are still trying to receive benefits.

To prevent this type of fraud, many employers are now using biometric tools such as fingerprint scanners and facial recognition technology to track employee attendance at the workplace.

2. Double Dippers


Double dippers refer to individuals who try to collect more than one set of benefits from two different claims related to the same injury. In this type of scam, an individual may file a workers comp claim and then file a personal injury lawsuit against the employer to double dip on benefits received.

Employers should regularly review claims filed and actively investigate suspicious activity to prevent this kind of fraud.

3. Medical Provider Fraud

This type of insurance fraud occurs when medical providers submit false information or bills for services never provided to receive higher reimbursement rates from insurers. To avoid this type of scam, employers should ensure that their worker’s compensation policies have strict anti-fraud measures in place, such as requiring medical providers to submit detailed documentation for any services rendered as well as proof that these services were indeed necessary for the treatment of the injury or illness in question.

4. Exaggerating the Injury


Exaggerating an injury occurs when someone attempts to increase the severity or extent of their damage to receive a more significant settlement amount than they would typically be eligible for under the terms of their policy.

Employers can combat this type of insurance fraud by conducting periodic reviews and monitoring changes made to existing claims—such as increases in severity level—to detect any suspicious activity early on.

5. Fraudulent Insurance Certificates

Fraudulent insurance certificates occur when someone uses fraudulent paperwork (such as fake certificates) to obtain insurance coverage without actually having it—or without paying premiums—in effect, defrauding both the insurer and employee alike out of their legitimate benefits due to them under their policy terms.

Employers can help protect themselves against this type of scam by verifying any submitted certificates with the issuing company before acceptance and payment for services rendered under those certificates.


Examples of Workers Comp Insurance Fraud ─ In Conclusion

Workers comp insurance fraud can cause serious damage if left unchecked, so employers and insurers must always watch their policies and practices. It’s important to take proactive steps such as monitoring changes made over time on existing claims and verifying submitted documents before payment is issued.

By utilizing biometric tools like facial recognition technology where appropriate, employers can significantly reduce their chances of becoming victims of workers comp insurance fraud while ensuring everyone gets what they deserve under their policy terms — a win-win situation. Thank you for reading; we hope this information was helpful.

About Nina Smith