Metro Articles

Work Comp Fraud and You

Nathan Smith Tuesday, June 14, 2011

Everyone knows that work comp fraud is a big problem facing many businesses today. Millions of dollars each year is paid our for bogus claims and just one can cause a business to downsize or close their doors altogether. Businesses pass along the cost of higher premiums to the consumer and employees are robbed of funds needed to give them their raises and bonuses. After servicing our clients for over 20 years, Metro Insurance knows a little prevention can go a long way. When, not if, you get your next work comp claim, you'll be glad you put these simple suggestions to work for you in your business...

Write a statement regarding your policy on workers' compensation fraud
This statement should include a clear and strong statement about the importance of promptly reporting all suspected accidents and injuries. Here's a sample statement to get you started. Make sure it mentions that filing false claims in grounds for discharge and may subject the employee to criminal prosecution. Have your employees sign this statement. Post fraud awareness posters (and safety posters) in your workplace so they know that it affects business operations, job security, and wages.

Conduct a work comp fraud meeting with your supervisors and managers that discusses the following:
- Who an injured worker should meet with to complete a report of injury
- The importance of investigating the facts early, and taking witness statements
- The supervisor's duty to make sure the employee gets prompt and appropriate medical care
- That any injury, no matter how minor, should be reviewed, investigated, documented and treated as a possible claim.

Maintain current addresses for all employees
Having your employees periodically update their personal information is key in preventing a break of communication. If they suffer from a workplace-related injury, you need to be in immediate contact with them.

Obtain accurate information
An investigation should immediately begin after any workplace related injury. Take a statement about the nature of the accident and exactly what injury it caused. It is important that the injured employee be recorded in their own words - ask them to be specific and ask them to sign the statement. This form should include a paragraph regarding the criminal penalties for making false statements.

Be diligent in reporting the injury to the carrier
Don't let just anyone fill out injury report forms. Have an experienced person promptly complete the forms and pass along any suspicious circumstances that may require further investigation. Waiting to file a claim means you will likely see an increase in lost time, medical expenses, and litigation costs.

Obtain prompt medical attention
When possible, have the supervisor accompany the employee to the medical provider for emergency treatment, or with their permission, to non-emergency medical treatment. Observe the quality of treatment and report any problems to the company and carrier. "Getting injured workers to high-quality doctors that are savvy to occupational medicine is one of your best means to avoiding exaggerated claims."

Stay in touch with your injured employee
Let your employee know that you care about him/her. Ask them about their treatment and encourage them to keep appointments. Ask if you can personally drop off compensation checks, then observe the employee's actions at home and their surroundings. They should not look as if they just finished strenuous work.

Work with your adjuster
Insurance adjusters work hundreds of cases at a time, so maintain regular contact with your assigned adjuster. Let them know when the employee returns to work so that indemnity payments can be canceled or reduced.

Maintain a safe workplace
Identifying and removing potential hazards, properly training your employees, and enforcing safe workplace habits are your best bet at preventing work comp claims. Let everyone know you are concerned about safety and that they should help you in your goal to create a safe working environment. Holding safety meetings will help you identify potential hazards and help stop work comp fraud before it happens.

Metro Insurance is here to help you with your work comp questions. Call us at 800-640-4430 and we'll be glad to help you find the answers you need.

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