Preventing workers compensation fraud in your business

American Family Insurance values and appreciates the active role you play in your workers compensation insurance decisions — which is why we want to keep you in the know by providing you with our anti-fraud reference guide.

While instances of workers compensation fraud are rare, it can lead to premium increases if not controlled. American Family prides itself on doing everything we can to prevent fraud from impacting our prices and asks for your help in our effort to protect your rates.

Familiarize yourself with the types of fraud

• Faking or causing an injury
• Claiming a non-work injury as a work injury
• Falsifying treatment that was not rendered
• Lying about lost wages
• Working for another employer while collecting benefits
• Returning to work while collecting benefits
• Misrepresenting the seriousness of an injury

Investigate all accidents

Not only will this help you remedy any hazardous situations in your work environment, it will also uncover signs of possible fraud. This includes interviewing witnesses and reviewing video surveillance, if available.

Identify potential fraud incidents

The National Insurance Crime Bureau suggests that a claim might be fraudulent when two or more of these are present:

• Rumors of foul play
• Unusually long time between when the claim occurred and when it is reported (especially if the injury is serious)
• The employee can never be reached at home or provides a pager as the main number
• The employee switches doctors after being released to work
• The employee’s story of the accident changes
• The accident happened outside of the employee’s normal working hours
• No one witnessed the injury

Educate your employees about the financial impact

Discuss your workers compensation policies and procedures with your employees, including what to do when an injury occurs and your stance on fraud. Let them know that fraudulent claims lead to higher insurance costs, which can impact the amount of money your company has for their other benefits.

Hold exit interviews

Part of your exit interview should indicate a signed statement from the employee as to whether or not they experienced an unreported injury at work. This will discourage post-termination claims.

If you do suspect an employee has filed a fraudulent claim, notify your American Family agent or workers compensation claim representative. We will then perform an independent investigation to further verify the nature of the claim.

This article is for informational purposes only. The information is widely available through different sources. This information does not, and is not intended to, constitute legal advice. Compliance does not guarantee conformity with building codes, or federal, state, or local laws and regulations, nor does it guarantee coverage. We do not make any guarantees or promise any results based on this information. We are not responsible for the content of any third-party sites that may be linked in this article.

The loss control services listed above follow generally accepted safety standards. Compliance does not guarantee that you will be in conformance with any building code, or federal, state, or local regulations regarding safety or fire. Compliance does not ensure the absolute safety of your operations or place of business.