Preventing workers’ compensation fraud is critical for businesses, honest workers, and everyone within the work comp ecosystem. According to the California Department of Insurance, based on estimates by the National Insurance Crime Bureau (NICB), workers’ compensation fraud is a $30 billion problem annually in the United States. In California, it is estimated that workers’ compensation fraud costs the state between $1 billion to $3 billion per year.
Decades of experience detecting, deterring, and defeating insurance fraud have shown the following strategies are key to preventing work comp fraud:
- Establish Clear Policies. Have clear, written policies and procedures for reporting workplace injuries and filing workers’ compensation claims. Employees should be aware of these policies.
- Educate Employees. Provide recurring training and education to staff about workers’ compensation benefits and the appropriate procedures for reporting injuries. Employees should also be aware of the consequences of fraud to both themselves and the business.
- Maintain a Safe Work Environment. Promote a culture of safety in the workplace to reduce the likelihood of injuries. Implement safety programs, training, and recurrent safety inspections.
- Promptly Report Injuries. Encourage employees to report injuries promptly. Failure to do so may adversely impact the ability to successfully investigate the claim.
- Fraud Hotline. Implement a confidential fraud hotline where employees, coworkers, or the public may report suspicious activity or suspected fraud.
- Return-to-Work Programs. Develop return-to-work programs to facilitate an injured employee’s return to the workforce as soon as medically able. This may reduce the extent and cost of claims.
- Documentation. Implement superior documentation protocols. Maintain detailed records of all claim-related material, photographs and video evidence, interviews of relevant personnel, and related materials.
- Collaborate with ICW Group. We will work closely with you to identify red flags and share information that can help combat fraud. Let us know if you question the validity of the claim.
Preventing workers’ compensation fraud requires a combination of proactive measures, employee education, and vigilant monitoring to be effective. ICW Group and its Special Investigations Unit look forward to partnering with you to stop fraud in its tracks!
