Workers Compensation and Fraud

Workers Compensation and Fraud

Orlando, FL – The lure of the money involved in workers compensation benefits is enough temptation for people to commit fraudulent acts. Costing individuals and the economy billions of dollars, these acts can be defined as a false statement or concealing of information, that a worker, an employee, and/or even an intermediary do to receive the benefits themselves or prevent someone from receiving them.

Workers’ Compensation Fraud

Workers’ Compensation fraud constitutes more than just being a hyperbolic case of medical conditions for workers, of billing for those medical services that they have never performed on part of the healthcare providers, and the underreporting of the payroll by employers to get lower premiums.

Employees can be said to be intentionally involved in workers’ compensation fraud when they claim with::

  • exaggerated symptoms
  • falsified mileage reports
  • a non-work related injury as a work-related injury
  • disability and no income while allegedly working

Additionally, they want to charge for an injury that has no witness other than themselves, have conflicting diagnosis from subsequent treating providers, is inconsistent with normal job duties, and in a location where they do not normally work. Even an injury that is reported at least after a week since its occurrence is considered a fraud.

Even though the emphasis until recently had been on employees not playing fair, when an employer tries to deduct premium dollars from their employee’s wages, misclassifies them for an insurance premium they are not entitled to, fails to have the required coverage for their workers, or denies valid claims, they can be reported concerning employer fraud. Other ways can be to issue late disability checks, engaging in bid rigging on insurance contracts, forcing the employee to litigate the claim.

Similarly, when the healthcare provider is caught treating injured workers with unnecessary medical testing services or billing the compensation insurer as well as the workers’ health insurer for one service in order to collect the financial advantage, they, too should be reported for fraud. A provider that submits boilerplate medical reports, issues bills that represent an unreasonable number of billable hours each day besides including in holiday dates for non-emergency situations, or appears to have a partnership with the respective authorities in handling workers’ compensation claims cannot be trusted too.

The number of studies that have been part of the system’s endeavors to recognize these activities testify for employee fraud to actually be less than 1% of all the claims made. On the other hand, the employers are believed to have a more significant role to play in these transactions.

Making Legitimate Efforts Worthwhile

The states have spurred up and reformed their laws to remain active on this front. Aggressive pursuing and imposing stiff criminal penalties highlights the way individuals and/or companies are more than willing and prepared to take the risk with this fraud.

One root cause that has been identified is that of huge incentives, i.e. the punishment is far less when compared to the payoff, especially in a society where everyone does it and there are zero chances of being prosecuted. One such case was the revelation of pervasive greed of two directors on board of the California Insurance Fund who continued to derive benefit in millions of dollars from the fund.

There is a need for an effective system to ensure policies are purchased, audits are conducted, and allow fraud investigators to shut down if the employer is avoiding responsibilities under the law of the state.

With Vaughan Law Group, you can save yourself from falling victim to the common schemes of benefit or premium fraud. Contact us at for further information.

Orlando Workers Compensation Attorney Contact Information

Contact Vaughan Law Group’s Orlando Workers Compensation Attorneys today for your free initial consultation. You can contact Vaughan Law Group at (407) 434-0074.