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Workers Compensation Fraud In New Jersey – Video Says It All

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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.

workers comp fraud picture french shell game
Wikimedia License – FaceMePLS

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:

  1. Employer – finding  illegal methods to not pay for the company’s workers comp risks
  2. Employee – intentionally filing for benefits not owed
  3. 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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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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