Workers' Compensation Fraud: How and Why (Part 1) | Tier 1 ...

Over the next several weeks Tier 1 will be reporting on various types of fraud we have helped insurance companies recover on. Tier 1 Solutions combines years of traditional experience with the latest high-tech advancements to provide the highest quality Workers' Compensation Fraud investigation possible. Call us at 1-866-610-6492 for more information or use our contact form to send us an email.

Workers' Compensation Fraud - How and Why (Part 1)

The motivations for workers' compensation fraud are fairly obvious. The first is money. As we mentioned previously, in some cases it is found that doctors involved in the fraud will offer the employee a cut of the insurance payout as incentive. Other times it is as straight-forward as the worker just being paid for the time off for their "injury." Many workers participating in workers' compensation fraud also take a secret side job while they are taking paid time off. They will receive the lost wages from their compensation claim while also earning extra money from their side job.

Often, workers participating in workers' compensation fraud just want a free vacation. These criminals will collect insurance money while claiming they are too disabled to work, and all the while will be playing sports, taking road trips, weight lifting, jet skiing, or even skydiving. It has been found that in some cases workers will suffer injuries while on their "vacation" and then modify their original claim, getting even more time off and additional money.

The motives are clear, but the "How" is so vast that we are turning it into a two part report. This week we will cover five popular methods that employees use to defraud the workers' compensation system.

A frequently seen scenario is when a worker gets hurt off the job, but either does not want to pay the co-pays on their insurance or simply views it as a money-making opportunity. A worker may sprain their ankle playing soccer or bruise a rib working on their car, pretends to act fine, then creates a dramatic show at work pretending to get injured. The worker then files a workers' compensation claim and leaves their employer to front the bill.

Similar to this scenario is when a worker has an old injury, such as a damaged knee ligament from sports, but will one day claim that she got hurt on the job. They will then file a workers' compensation claim.

Sometimes a worker will actually get hurt on the job, but something minor such as some brief muscle pain or twisting their neck. The worker will inflate the nature of their injuries, and sometimes work with a doctor to defraud the insurance system, getting time off and money for their claim.

If a worker has been injured legitimately, it has been found that they often drag out their recovery much longer than needed. They will continue to receive benefits and time off while being completely healthy.

Workers have also been know to simply invent an injury. Soft-tissue injuries like sprains or muscle problems are some of the most popular, and big-ticket, scams. Doctors often have trouble diagnosing these problems and are more likely to agree with what the worker says.

Stay tuned next week for part 2, where we will go in further detail of how workers seek to defraud you and your business by abusing the workers' compensation system.

It's time for you to take control!

For Workers' Compensation Fraud, contact Tier 1. Tier 1 is licensed in investigation throughout California, Arizona and Nevada. Contacting us online is safe, secure, and anonymous.

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