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EMD Blog

What is Workers’ Comp Fraud?

Erwin, McCane & Daly | Thursday, January 15, 2015

Knowingly and intentionally makes a false, material statement in order to obtain or deny a benefit for themselves or another is the definition of workers’ compensation fraud.

Honest Mistakes

It goes without saying, but people do make mistakes. When it comes to a fraud investigation, it must be shown that there was intent behind the fraud, otherwise a mistake is not classified as such.

Employers Methods of Fraud Can Include:

• Employers falsifying documents to avoid paying premiums to people injured at work

• Misleading workers to discourage them from making a workers’ comp claim

• Employers falsifying documentation to make it appear that their workers are covered when they really aren’t

• Misclassifying their business type to lower their insurance premiums

• Employers failing to keep and maintain accurate records

• Employers failing to inform workers that they are entitled to compensation benefits from their first day of work

Health Care Methods of Fraud Can Include:

• The submission of false medical reports or inflating care costs and prices charged to the compensation fund