Workers Compensation Fraud – New Jersey Man Caught on Video
Workers Compensation fraud appears very rarely in the articles on this blog. (Why?) The subject remains one of the most overused and overwritten subjects since I first started in the business in the last part of the 1980s.
The Workers Compensation newswires and blogospheres lit up the scoreboard with a video obtained by CBS News. The video- see the end of the article for link shows a very feeble attempt at workers compensation fraud by an employee.
As you may already know, three types of workers compensation fraud are the most prevalent:
- Employer – finding illegal methods to not pay for the company’s workers comp risks
- Employee – intentionally filing for benefits not owed
- Provider – billing for services not provided to the injured employee
Many years ago, a study was conducted – by a now-defunct carrier – that covered the elements of fraud. Three percent of claims started with an element of workers compensation fraud. As the claim progresses, the likelihood the same claim contains an element of fraud increases to 30%.
An assumption would be that the element of fraud could be from one of the three listed above, and not caused just by the injured employee.
One of the areas that Predictive Analyses made at least a few inroads was in the area of fraud detection at the beginning of a claim. I had seen some success identifying certain factors that pointed towards a claim that could have workers comp fraud.
No big breaking news stories were published on fraud detection using Predictive Analytics. An experienced workers compensation adjuster, to me, can be the best detector of fraud during a claim. Every adjuster (medical only and lot time) possess an innate ability to know when a claim heads off the rails.
One of my pet peeves on workers compensation fraud detection came from a list I was provided by my employer 25 years ago. The list contained a few suggestions as to what claimants might have an ulterior motive in filing a claim.
The list contained – has a PO Box. After having my credit card numbers stolen in the 1990’s out of my residential mailbox and multiple accounts opened using the ill-begotten info, I have used a PO Box for at least 25 years for credit card fraud avoidance.
I do not think there exists one bellwether on whether a claim will have some fraudulent element. One that used to concern me when I was handling a full claims count was injured the first day of beginning a job. My opinion was changed somewhat after learning how much The Learning Curve affected a new employee.
OK, so the link to the video is here. The man in the video has been charged with but not convicted of workers comp fraud.
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