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Workers' Compensation Fraud

Workers' Compensation Fraud
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If you believe the headlines, lay-about workers are responsible for most workers' compensation fraud. The insurance companies, in particular, have helped create the myth that many people fake their on-the-job injuries in order to fraudulently collect workers' compensation benefits.

But the truth is, worker fraud is much less common and much less costly than employer and insurance company fraud. In virtually every independent study, worker fraud has been found to be less than 2 percent of total claims.

A recent article in Workers First Watch, a publication of the Workers Injury Law and Advocacy Group (www.wilg.org) provided facts about the cost and prevalence of employer and insurance company workers' compensation fraud.

Among the article's findings:

  • Florida, which has been aggressive in tackling workers' compensation fraud, recorded 178 fraud convictions out of 54,854 claims filed in 2005. Of those convictions, 130 were against employers.
  • In Kansas, 89 percent of fraud complaints were levied against employers. Only 80 of 66,469 employees who filed workers' compensation claims in the state in 2006 were investigated for fraud.
  • As part of 2004 Workers' Compensation Reform Act, Tennessee implemented a penalty program to combat fraud. Since that time, the program has collected nearly $300,000 from workers' compensation insurance carriers and employers.
  • In New York, a 2007 report by the Fiscal Policy Institute concluded that 25 percent to 30 percent of all companies in New York are not purchasing required workers' compensation insurance. This non-compliance is costing between $500 million and $1 billion annually.

For injured workers, however, the cost of workers' compensation fraud is great. When employers fail to carry workers' compensation insurance, the cost of medical treatment and other care falls to the injured, as well as to taxpayers in general, through government and social services agencies.

There's also considerable fallout from the widespread belief that workers are defrauding the workers' compensation system in large numbers. In fact, the notion that employee fraud is rampant has helped win approval for draconian workers' compensation reform efforts in many states.

Other effects of this misinformation:

  • Some states are cutting benefits for injured workers for the purpose of making it less worthwhile to commit fraud.
  • Many employers treat people who file for workers' compensation as lazy frauds even when they have suffered legitimate injuries.
  • Insurance companies have helped perpetuate the myth and are buying into it, as well. Many treat every claim with suspicion, meaning injured workers face a difficult uphill battle when trying to secure workers' comp benefits.
  • Thanks to sensational news reports and inaccurate anecdotal examples, the general public has bought into the notion that most people who are collecting worker's compensation benefits do not deserve them. Because of this stigma, some injured workers may not even file for benefits.

Fraud also hurts honest employers, who pay higher premiums to make up for those companies that do not carry workers' compensation insurance. In some industries, such as construction, honest companies also face a competitive disadvantage because they can't match the rates offered by non-compliant companies.

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