Legal problems – Text
Check unknown vocabulary before you read the text:
to spy on sb. – to observe a person secretively, often with hostile intent
to commit (a crime/fraud/murder/suicide…) – to do / perform
to trickle down – to pertain to, to have reference or relation to
premium – the amount paid or payable for an insurance policy.
to lurk – to go furtively; slink; steal.
to exaggerate – to represent as greater than is actually the case; to make overstatements
sure-fire (way) – certain to be successful
disgruntled – displeased and discontented
to fabricate – to devise or invent (a legend, lie, etc.)
sound (hiring policy) – following in a systematic pattern without any apparent defect in logic
lay off (an employee) – to dismiss (an employee)
belligerent – of warlike character; aggressively hostile
Workers' Compensation Fraud Growing Problem
A small business in Waco suffered four workers’ compensation claims in one year. The claims were so costly that the owner feared for her business. Desperate, she spied on her injured employees outside their chiropractor’s office to see if they were committingworkers’ compensation fraud.
Did she over-react? Small business owners watching their bottom lines would probably say “no.” Every year, workers’ compensation fraud costs the system millions of dollars. Those costs trickle down to all employers in the form of higher premiums.
Fortunately, employers don’t have to lurk in dark alleys with a camcorder to keep their businesses from becoming victims of workers’ compensation fraud. They can learn to identify fraud and take a proactive approach to fighting it.
What Is Workers' Compensation Fraud
Claimant fraud is the most talked about kind of fraud. It is also the type that employers are in the best position to help uncover. Claimant fraud happens when employees knowingly lie to collect benefits. They may claim an injury was work-related when it wasn’t,exaggerate an injury, or secretly continue working while collecting benefits.
What Workers' Compensation Fraud Is Not
Collecting benefits for a work-related injury is not fraud. Many employers feel that the longer an employee stays off work and collects benefits, the more likely the claim is fraudulent. Under state law, injured employees don’t have to get back on the job until the doctor releases them to work.
Red Flags for Workers' Compensation Fraud
There is no sure-fire way to identify fraud without proof, but there are red flags. Employers should call their carriers immediately if they identify two or more of these flags.
- Disgruntled employee. The employee has a motive to fabricate the claim. Perhaps he or she was denied vacation time, demoted or fired.
- Employee is hard to contact. The employee may be working another job while collecting benefits. This practice, called “double-dipping,” constitutes fraud.
- New employee. Statistically, the newer the employee is, the more likely the claim is fraudulent, especially if other red flags appear.
- No witnesses. Make note of alleged accidents with no witnesses, especially if the employee’s duties rarely call for him or her to work alone.
- Varying accounts of accident. The injured worker may describe the accident differently to the employer and the doctor, or witnesses’ accounts may differ from the injured worker’s account.
- Accidents on Fridays or Mondays. Accidents that occur on Fridays or Mondays should raise suspicion, especially if other red flags appear.
Be proactive
It is easier to prevent workers compensation fraud than it is to prove it. Employers should make sure new hires have the skills and the character they want in their employees. A sound hiring policy is the best place to start.
- Hire wisely. Conduct background checks on applicants, and verify references.
- Focus on safety. Making the workplace safer reduces the chance of accidents and the opportunity for someone to fake an injury.
- Develop a return-to-work policy. Tell job candidates that if they get injured on the job, the company will work with the doctor to help them return to work as soon as medically reasonable.
- Educate, don’t threaten. Explain that workers compensation fraud hurts everyone, not just the insurance carrier.
Let employees know that fraudulent claims can force employers to decrease benefits, lay off employees, or go out of business.
- Adopt a zero-tolerance policy. Make it clear that fraud can carry serious consequences, including termination and prosecution.
- Stay in touch. Keep regular contact with employees who are off work due to an injury. Document each contact or attempted contact. Injured workers who are difficult to contact or who are belligerent may be workers committing compensation fraud.