What is Workers' Compensation Fraud
What is Fraud
Fraud occurs when a person knowingly or intentionally conceals, misrepresents, and makes a false statement to either deny or obtain workers' compensation benefits or insurance coverage, or otherwise profit from the deceit. The key to conviction is proving in court that the misrepresentation or concealment occurred knowingly or intentionally.
Premium fraud and benefit fraud are the most common types of workers compensation fraud.
Premium fraud is usually committed by an employer who misrepresents the amount of payroll or classification of employees, or who attempts to avoid a higher insurance risk modifier by transferring employees to a new business entity rated as a lower risk category.
Benefit fraud is usually committed by: a worker who works full time at an unreported job and draws benefits when he or she is supposed to be unable to work, or when a worker fakes an injury; a health care provider or attorney who assists the worker in fraudulent schemes, participates in double billing or bills for services not provided.
An insurance carrier commits fraud if documents are intentionally falsified in order to deprive benefits. Fraud Indicators Fraud indicators do not mean fraud has occurred, but they may require a closer review of the claim or application. Employer fraud indicators include but are not limited to: classification codes not consistent with duties normally associated with the employer's type of business, for example, a construction company that reports mainly clerical classifications payroll information on the insurance application inconsistent with payroll reported to the Workforce Commission, much larger premium paid for the previous year's policy small payroll reported by a large company or employee leasing company frequent addition and cancellation of coverage, especially if several business entities appear to be owned or controlled by the same person or group.
Employee fraud indicators include but are not limited to; injuries that have no witness other than the worker, injuries occurring late Friday or early Monday, injuries not reported until a week or more after they occur, injuries occurring before a strike or holiday, or in anticipation of lay off or termination, injuries occurring where the worker would not usually work, injuries not usually occurring in the particular job description, for example, a secretary injured when lifting a heavy object, worker observed in activities inconsistent with the reported injury, worker history of workers compensation claims, conflicting diagnosis from subsequent treating doctors, any evidence of working elsewhere while drawing benefits.
Attorney/health care provider fraud indicators include; receiving bills or explanation of benefits for services from health care providers, insurers or attorneys that seem unnecessary or fictitious boilerplate medical reports, or reports that are merely copies of previously submitted reports, treatment dates on holidays for non-emergency situations, bills from a health care provider or attorney that present an unreasonable amount of hours per day, complaints from the worker that the attorney is (never) available although the attorney files fee affidavits for services, attorney relationship with a health care provider that appears to be a partnership in handling workers' compensation claims.
Do not modify this article Workers Compensation Law Workers Compensation Law - information to help you understand your rights and obligations. webmaster@worker-comp-law.com
|
- New Form of Click Fraud Discovered
If you use PPC advertising and are in a highly competitive market, you cant afford not to read this. You already know that if youre adventurous enough to run your own pay-per-click advertising campaign--e.g.,...
- When to Fight Identity Theft
The time to fight Identity theft is now. If you are not a victim of identity theft, do not take any chances, since it is next to impossible if not impossible to restore your life once someone takes hold...
- Identity Theft And The Internet
LexisNexis, a provider of personal and financial data, recently reported that the personal information of as many as 310,000 people nationwide may have been stolen. This figure is nearly 10 times higher...
- Identity Theft Tips
Identity theft is an ongoing crime, that in the year of 2004 alone more than eleven million victims lost their identity. Now that we are in recession, the world is in chaos more so than ever and many people...
- Thievery of Identity
Thieves that focus on taking other peoples identities are often the worse thieves there are in society. We have petty thieves, grand thieves, and other types of thieves, but identity thieves claim the...
- Internet Privacy a Growing Concern
Lets face it, we look at stuff on the internet, in the privacy of our own homes that we would never look at in public. How often do you walk into your local bookstore and proudly by the latest Penthouse...
- Identity Theft
LexisNexis, a provider of personal and financial data, recently reported that the personal information of as many as 310,000 people nationwide may have been stolen. This figure is nearly 10 times higher...
- Immediate Rules Identity Theft
Unfortunately, all of us are potential victims of identity theft. If you fall into the hands of identity theft, you will need to know the next steps to take to protect your self as much as possible. First,...
- ID Theft - Are You the Next Victim?
Identity theft is on the rise. One in ten of us have , or will be the victim of this crime. It is estimated that 500,000 to 700,000 Amercians become victims to indentity theft each year. You dont have...
- Identity Theft Right Away
If you feel that your identity is stolen, inform the appropriate authorities immediately, including your bank, credit card issuers. The earlier you inform the credit card suppliers, banks, et cetera the...
- Credit Fraud Secrets Thieves Don't Want You To Know
Have you ever been a victim of credit card fraud? If so, you know just how traumatic it can be. Whats more, if you dont detected it early enough, it could leave bad marks on your credit report that could...
- Crime and Identity Theft
What is crime? Crime defined is an atrocity or enslavement, an act carried out by a single or group of individuals, targeting the population, or a set area to attack. When an identity thief gets hold of...
- Identity Theft and Your Online Job Search
While identity theft is nothing new, the Web has opened up whole new world of opportunity for identity thieves.According to the FBI, identity theft is the top online fraud. The U.S. Federal Trade Commission...
- Finding Peace after Identity Theft
When a person fall victim of identity theft, rarely do they find peace thereafter. Victims of identity theft often struggle with paperwork, reports, credit reports, courts, police and the list goes on....
- How to be Active in Credit Card Fraud Prevention
Credit card fraud is a matter of great concern to both, the cardholders, and us - the merchants who sell the merchandize. A majority of credit card frauds is carried out online. A majority of the Internet...
- The Criminal Mind and Identity Theft
After studying human behaviors, crimes, criminals, emotions, thoughts, and various other subjects and surviving many crimes, I feel it is important to understand the criminal mind to a degree when fighting...
- Identity Theft Taking Over
Identity thieves are taking over millions of lives each year, and the studies are showing the law is making very little headway in stopping the crimes from occurring. Recently, studies have shown that...
- Tips to Avoid Identity Theft
What is rampant, spreading like wildfire and can kill life as you know it? No, not a deadly virus (but close). Answer: Identity theft. My stepson, Aaron, was a victim of identity theft recently. Someone...
|
|
|
|
