Steps to Help Detect, Deter, and Defeat Work Comp Insurance Fraud

Continuing its position as an industry leader in fighting work comp insurance fraud, ICW Group’s Special Investigations Unit recently presented at the 38th Combined Claims Conference in Garden Grove, Calif. The conference attracts hundreds of claims-related professionals for two days of topical sessions. ICW Group’s session was titled Intersection of Workers’ Compensation and Fraud.

Attendees learned the definition of fraud (the intentional deception or misrepresentation to obtain undeserved benefits) and the acronym for spotting it, M.I.L.K. (Material, Intent, Lie, and Knowledge).

The presentation also covered a wide range of topics, including several steps employers can consider implementing as part of a holistic approach to detecting, deterring, and defeating work comp insurance fraud. Here are the steps we shared:

Reporting Suspicions (SPOT IT & STOP IT!)Foster an open environment where employees feel comfortable discussing concerns and reporting suspicious activities.

Training Programs—Prevention through education is a great way to combat ever-evolving fraud schemes proactively. Current ICW Group customers can visit our Policyholder Center for more information on how ICW Group can partner with you to educate your employees regarding workers’ compensation fraud schemes and their impact on your business.

Culture—Create and reinforce a comprehensive safety culture throughout the organization. Promote a culture of honesty and integrity through ethics training and clear communication of company values.

Technology—Implement appropriate tools, such as video surveillance, vehicle GPS/cameras, and access controls, to dissuade suspect claims and validate legitimate claims.

Robust internal controls to help prevent fraud

  1. Ensure segregation of duties. No single employee should have control over all aspects of a financial transaction. This reduces the risk of fraudulent activities going undetected.
  2. Be sure to conduct regular audits. Conducting regular internal and external audits helps identify discrepancies and enforce accountability.

Put in place thorough verification processes 

  1. Strengthen identity verification processes to prevent fraud through the use of fake or stolen identities.
  2. Conduct thorough background checks on new hires, especially those in sensitive positions.

A critical aspect of any successful anti-fraud program is collaboration and communication between employers and their insurers. At ICW Group, we are ready to partner with you to detect, deter, and defeat insurance fraud.

Brian Biggs
Brian Biggs
Brian serves as the Manager of ICW Group’s SIU team. He has been in the industry since 1997 in a variety of roles including Claim Professional, SIU Investigator and SIU Director. Brian has previously been elected President of multiple anti-fraud industry trade organizations and is joining the Board of the Anti-Fraud Alliance in early 2024. He has attained more than fifteen professional designations including the CPCU, Certified Insurance Fraud Investigator and Associate in Risk Management. Brian is frequently asked to present at conferences and industry meetings and revels at these opportunities. Brian welcomes the opportunity to speak with anyone, anywhere, anytime about insurance fraud (and all manner of BBQ).

Related Articles

Red Flags Point to Possible Work Comp Fraud

Earlier this year, ICW Group received a claim for a 57-year-old truck driver who was a new hire for our insured. On his fifth day of employment, the worker...

Don’t Let Passport Renewal Scams Disrupt Your Vacation

You have an exciting international trip planned and you search online for how to renew your passport. According to the Better Business Bureau, consumers unaware of the passport renewal...

Beware of Online Job Scams

As of May 2024, the national unemployment rate was 4 percent, a whopping 10 percent less than at the start of 2020, when more than 23 million Americans lost...