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What Are Examples of Workers’ Compensation Fraud?

Workers’ compensation insurance covers medical expenses and lost income for employees who get hurt or sick on the job. But like other insurance industries with so much money in the system, it can be a target of fraud.

Some of the most common examples of workers’ compensation fraud include double dipping, medical provider fraud, personal time fraud, injury exaggeration, and fraudulent insurance certificates. A lawyer from our firm can help you learn more about workers’ insurance fraud and file a claim for benefits.

What Is Workers’ Compensation?

Suffering an injury on the job that forces you out of work, whether temporarily or permanently, can feel terrifying, especially if you and your family are experiencing a financial crunch. On top of that, you now have medical bills to keep up with, and you’re not sure what to do.

Fortunately, you can file a workers’ compensation claim to recover benefits to pay your medical expenses and cover your lost income. Workers’ compensation is insurance that an employer must provide for their employees, according to LAB § 3700. If you get hurt at work, you should inform your employer, who must then provide you with a claim form. After you file your claim, your employer’s claims administrator will review it and approve or deny it.

Even prior to approval, you will receive up to $10,000 to cover your medical treatment. If your medical bills are higher than that, you will likely receive more coverage after approval. However, with so much money in a vast system, there is bound to be some fraud.

Examples of Workers’ Compensation Fraud

Insurance providers are a common target of fraud. This includes workers’ compensation insurance. In fact, the National Insurance Crime Bureau (NICB) reports that workers’ compensation fraud costs businesses $30 billion every year in the United States.

It’s a staggering amount that only makes workers’ compensation insurance a prime target of fraud. There are several kinds of workers’ compensation fraud, but five of the most common are double dipping, personal time fraud, medical provider fraud, fraudulent insurance certificates, and injury exaggeration.

Double Dipping

When an employee is hurt, they must receive clearance from a doctor to return to work. In the meantime, the employee collects workers’ compensation benefits to cover lost income. However, if the employee goes back to work without clearance and earns a paycheck while also collecting benefits, that’s what is known as double dipping.

It can harm a business because the employer is paying for workers’ compensation insurance while simultaneously paying an employee who is receiving benefits. If the employee worsens their injury by working without clearance, it’s the employer’s fault for allowing the employee to work.

Personal Time Fraud

If a business fails to do its due diligence after an employee reports an injury or illness, the employee could end up drawing workers’ compensation benefits for something that did not even happen while on the job. Personal time fraud occurs when an employee files a claim for an injury that happened off the clock, such as after work hours or on a day off.

An example of this would be an employee getting hurt over the weekend and then reporting it as a workplace injury upon returning to work on Monday. This is why businesses must investigate thoroughly to confirm their employee got hurt at work.

Medical Provider Fraud

It’s not just an employee who can commit workers’ compensation fraud. A medical provider can do it as well. This happens when a medical provider inflates the cost of treatment or makes up a cost in an effort to get workers’ compensation to cover a higher cost to get more money.

Injury Exaggeration

If an employee fakes an injury or exaggerates the severity of an injury, they can face serious legal penalties, such as fines and repayment. An example of this would be an employee faking a back injury while on the job or claiming that a legitimate injury is worse than it seems.

However, employers and claims administrators can check this by having a doctor confirm via an examination and tests. Often, an employee will give themselves away by posting photos on social media and participating in activities a real injury would likely prevent.

Insurance Certificate Fraud

An employer can engage in workers’ compensation fraud by claiming to have a workers’ compensation insurance policy when they don’t actually have one. If a business hires employees of a subcontractor to do a job and the employee gets hurt, the subcontractor’s principal employer is responsible for providing workers’ compensation. But if the employer does not have insurance, the business hiring the subcontractor could be on the hook.

How Can a Workers’ Compensation Attorney Help Your Case?

Our law firm has the experience and training to help you file a workers’ compensation claim and recover the money you deserve for your losses.

If the claims administrator denies your claim, we will investigate and collect the evidence necessary to challenge the decision and seek a reversal. We will calculate the value of your claim, negotiate a fair settlement on your behalf, file a lawsuit (if necessary), and represent you at hearings.

You work hard at work to take care of your family. If you get hurt at work, workers’ compensation should take care of you.

Learn More About Workers’ Compensation Fraud Today

Workers’ compensation provides employees with money to cover their medical expenses and lost income. Unfortunately, fraud happens, and when it does, it costs businesses money and does harm to the system. Your claim may be legitimate, but the claims administrator can make you jump through extra hoops to justify approving your claim. A workers’ compensation attorney from KJT Law Group can help you file your claim and challenge a denial. To learn more about workers’ compensation fraud during a free consultation, please contact us at(818) 507-8525 today.

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