Committed by employees, employers or medical providers, Workers’ Compensation fraud can cost thousands of dollars and jeopardize your job. Understand this type of fraud and how you can avoid it as you protect yourself and your future. 
What is Workers’ Compensation Fraud?
When an employee, employer or provider makes a false statement or conceals information about a work-related injury or treatment, Workers’ Compensation fraud occurs. The fraud typically allows or hinders a person from receiving benefits.
Consider these three categories of Workers’ Compensation fraud.
Claim Fraud
- Claiming an injury that did not occur or exaggerating symptoms.
- Filing a claim for a non-work injury or illness.
- Claiming ongoing symptoms after successful treatment.
- Working while receiving benefits but not reporting that income.
Employer Fraud
- Failing to purchase adequate Workers’ Compensation coverage.
- Misclassifying employees or underreporting payroll to cut insurance premium costs.
- Deducting insurance premium payments from employee wages.
Health Care or Medical Provider Fraud
- Ordering unnecessary testing or treatment for financial gain.
- Billing for treatment or services that never occurred.
- Billing the employee’s Workers’ Compensation and health insurer for the same service.
How to Avoid Workers’ Compensation Fraud
A business or medical provider that commits Workers’ Compensation fraud could owe fines and related costs that lead to bankruptcy, or the fraudulent employee could be fired. It’s in everyone’s best interests to avoid fraud in several ways.
Always tell the truth.
From reporting an injury or illness to completing the final treatment paperwork, everyone in the Workers’ Compensation process should prioritize honesty. Never try to cheat the system in exchange for extra money.
Verify Workers’ Compensation insurance coverage.
Employers should ensure they purchase adequate Workers’ Compensation insurance for their employees. Employees should also verify Workers’ Compensation coverage before they accept a job.
For information on related insurance topics see Wire Transfer Fraud (Crime) and Exercise & Physical Fitness Centers Workers Compensation.
File and follow through on legitimate claims.
Employees who do suffer a work-related illness or injury should file a Workers’ Compensation claim, participate in the necessary treatment and model how benefits are supposed to work.
Hire an independent auditor.
Hold everyone accountable during the Workers’ Compensation claims process. Ideally, the auditor should be independent and unbiased while evaluating the company’s insurance coverage, claim legitimacy and treatment.
Use reputable medical and health care providers.
Every employer maintains a list of Workers’ Compensation medical and health care providers that injured or ill employees must see. Be aware at all times of fishy tactics, including unnecessary tests or extra claims.
Report Workers’ Compensation fraud.
Reach the Workers’ Compensation Fraud Division at 1-800-201-3362.
Workers’ Compensation fraud is your concern, whether you’re an employee, employer, or medical or health care provider. Do your part to avoid fraud and protect yourself, your job and your future. If you need additional help, consider talk to an agent to review your coverage and options.
Frequently Asked Questions
What counts as Workers’ Compensation fraud?
Fraud includes false statements, concealed information, or billing for services not provided that affect eligibility or payment of benefits.
Who can be held responsible for Workers’ Compensation fraud?
Employees, employers, and medical providers can all be held responsible depending on their role in the fraudulent activity.
How should I report suspected fraud?
Report suspected fraud to your state Workers’ Compensation fraud division or call the number provided by your employer; many states have a dedicated fraud hotline.
What happens if an employer doesn’t carry required coverage?
Employers who fail to carry adequate coverage may face fines, penalties, and increased liability, and employees may have different paths to recover benefits.