What is Workers’ Comp Fraud?


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.