What is Work Comp Fraud, Actually?

Fraud in the workers’ compensation landscape can be confusing. There is so much that goes on in an employer’s mind when it concerns a potential act of fraud by an employee. What exactly meets the definition of fraud? What’s needed to prove it? What can I do if I suspect fraud?

Fraud is a legal concept, and the elements may be complicated to remember, so here’s a better way to recall what’s needed to identify workers’ comp fraud-

B- Did they Benefit?

I-  Was the act Intentional?

T- Did they Tell a Lie?

E- Is there Evidence?

To pursue a suspected act of fraud, we must consider whether the employee benefitted from intentionally telling a lie and whether there is evidence to prove it. A lie without evidence is not enough. Evidence includes video surveillance or lack thereof, a statement under oath or to a doctor, or a lie when first reporting the injury to the employer for the First Report of Injury Form.

ICW Group has an internal team of investigators who are experts in fighting fraud and believe that the best defense against fraud is education. Policyholders have free anti-fraud collateral at their fingertips. Visit the Policyholder Center to find educational materials for your staff to help deter them from committing acts of fraud.

Teena Barton
Teena Barton
Teena is a Major Case Investigator with expertise in capping and organized crimes in healthcare fraud, collaborating with Insiders, and specializing in victimology. She was featured in a nationally covered story by Reveal News and NPR radio called “Billion Dollar Scam.” She is a national speaker and collaborates with an attorney convicted of selling clients to surgeons and who had a role in creating one of the most prolific organized capping schemes in US history to help inform the public. Teena is a former Police Officer/Criminal Investigator and a military veteran, having served during the Persian Gulf War, in Desert Storm/Desert Shield for the US Air Force. She is a Cum Laude graduate of Texas Christian University.

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