What Exactly Is Workers Compensation Fraud?
The three primary types of workers’ comp fraud are claimant fraud, provider fraud, and premium fraud. Each type will be described and examples provided. Claimant Fraud Claimant fraud–when an employee deliberately falsifies facts about an illness or injury to collect benefits–is the most commonly discussed form of workers’ comp fraud. Here are a few examples of how to recognize this type of fraud: • An employee becomes injured or sick and claims that it was caused by work-related circumstances when, in reality, it was not. • An employee experiences a minor accident and exaggerates the extent of the resulting injury. • An employee who has an injury claim collects benefits while secretly continuing to work or consciously participates in activities that otherwise would not be possible based on the extent of the reported injury and medical limitations. • A claimant with a legitimate injury or illness, who is capable of transitional work or modified duty, malingers and makes no effort to r
