Workers’ compensation is one
of the most abused benefits in U.S. frauds and swindles by both employers and
employees is a common thing. To understand the kind of scams people try to pull
off let’s understand what workers’ compensation exactly is.
What
is the workers’ Compensation?
It is a type of insurance; publically
sponsored system that pays monetary benefits to workers who are injured or
disabled in the course of their employment. This insurance offers compensation
to employees for injuries or disabilities caused directly by their employment.
If a worker agrees to receive workers’ compensation, he/she gives up their
right to sue their employer for negligence.
What
constitutes a Fraud in workers’ compensation?
Insurance fraud in workers’
compensation is an intentionally false representation of one's injury or disability
due to their employees to receive benefits. This alleged abuse of the system
contributes to a $7.2 billion loss annually.
I am citing a real-life
example to illustrate how pervasive insurance fraud is in workers’
compensation. My brother-in-law is Bob of our family (he owns a construction
company). Most of the workers are immigrants (and they are good people).
Surprisingly, an immigrant did not commit the fraud in fact it was a white woman
who tried to forge a false claim by faking an injury. The woman was hired by the company
to manage accounts, it was a desk job, and she did not even have to be close to
construction sites. The woman claimed that she was hit by a fire sprinkler head
that fell on her desk and then hit her head. My brother-in-law filed a
workers’ compensation claim. The insurer became suspicious of the claim and
referred it to the Division of Investigative and Forensic Services (DIFS). The DIFS
investigative officer asked for the CCTV footage from the day incident happened
and before that, it never occurred to my Brother-in-law to check the video
footage.
The video showed that while
the fire sprinkler head did fall on the desk it didn’t hit the woman. In fact,
she picked it up from the desk and when no one was watching, she hit herself
with it on the head. The woman was arrested and was charged with two counts of
insurance fraud.
Workers'
compensation reform:
The insurance industry is trying
to catch cheaters and malingerers, through national workers' compensation
reform but still there’s a long way to go as people assume false claims to
workers’ compensation is an easy and quick way to make money.
How
to avoid frauds:
There are some measures that
employers can take to avoid frauds regarding workers’ compensation in Sandy Springs.
- Ask employees to immediately report the injury/accident. Set a clear time window for reporting the accident in the policy.
- Conduct thorough investigations before filing a claim on behalf of the employee.
- If the employees take time off due to injury, stay in contact.
- Use surveillance equipment in the offices or on construction sites.
- Choose your insurance agent wisely. A good insurance provider can help you out with investigating false claims.
If you’re looking for a
trustworthy insurance company to get insurance regarding workers’ compensation in Sandy Springs, Tramites Express Insurance is one of the most reliable companies.
