Our anti-fraud staff has extensive law enforcement and criminal fraud investigation experience and has saved millions in fraudulent claims costs. Our fraud prevention efforts reduce expenses, which can help lower the cost of workers’ compensation insurance.
What is Workers’ Comp Fraud Prevention?
Workers’ compensation fraud and abuse are unfortunate but serious risks to both our policyholders and their injured employees. For this reason, EMPLOYERS has an experienced Fraud Investigations Department to help put policyholders’ minds at ease and keep their businesses running smoothly.
With over 100 years of combined law enforcement and prosecutorial experience, our Fraud Investigations Department operates a comprehensive Anti-Fraud Program dedicated to preventing insurance fraud and providing insurance fraud management. Our team of experts can help investigate and report cases of suspected insurance fraud and collaborate with state and local law enforcement to achieve results.
As part of our Anti-Fraud Program, agents and policyholders are trained to spot workers’ compensation fraud, learn anti-fraud techniques, implement business fraud prevention plans and services, and are provided with information to discourage their employees from committing workers’ compensation fraud.
How to Combat Workers’ Compensation Fraud
Small business owners may wonder how to combat workers’ compensation fraud proactively. Some proactive workers’ compensation fraud prevention measures include establishing a zero-tolerance policy on fraud, creating safe avenues for employees to report suspicions of fraud, and promoting an overall culture of safety so that there are fewer injuries and therefore fewer opportunities for injuries to be exaggerated.
An educated small business owner is also the frontline defense against workers’ comp fraud. We offer a free Fraud Prevention educational series that provides an educational look at workers’ comp fraud and how Employers handles these cases.
What are the most common fraud warning signs?
The warning signs for fraud depend on the type of fraud being committed. While incidents should be evaluated on a case-by-case basis, certain red flags are present in many fraudulent claims. When it comes to claim-related fraud, some common workers’ compensation fraud indicators include:
- Injuries with no witnesses
- Injuries reported first thing Monday morning
- The accident or medical report conflicts with the employee’s description of the incident
- The claimant is difficult to contact
- The claimant’s legal representation or medical providers have a history of managing questionable claims
These warning signs don’t always guarantee that a claim is fraudulent however, so it is best to allow the proper authorities and investigators to review cases further. The EMPLOYERS fraud hotline is an excellent resource for business owners who are suspicious about a claim or want additional guidance on fraud prevention.
Why is this important to my business?
Workers’ compensation fraud and abuse costs American business owners, employees and customers billions of dollars each year. Workers’ compensation fraud is a criminal offense and can result in jail time for perpetrators. Fraudulent claims can lead to higher insurance premiums for business owners. Increased claim scrutiny can also undermine honest workers who are legitimately injured on the job. Workers’ compensation fraud prevention can help protect businesses – and their employees -- from these undue hardships.
EMPLOYERS’ fraud prevention efforts reduce a small business owner’s expenses, which can help lower the total cost of their workers’ compensation insurance policy. To learn more, contact EMPLOYERS or your insurance agent today.