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Workers Comp Fraud – Reasons I Skip The Subject


Workers Comp Fraud – Why I Skip The Subject (Usually)

I am sometimes asked during presentations, at conferences, or just in general conversations why I rarely cover Workers Comp fraud in the 2,000 articles on this website.  I have covered fraud in a few instances over the last 15 years.  See the list at the end of this article for more info or click on the category for a full listing.

Workers Comp Fraud – The Unknown Variable

According to a PBS article, a study in 2000 showed that fraud cost employers $1.2 billion.

According to the National Insurance Crime Bureau, Work Comp fraud in 2017 cost employers $30 billion per year.  I am not sure how that figure was calculated or estimated as a yearly figure.

Did this figure grow from $1.2 to $30 billion in 17 years?  As one of the components of fraud is concealment, I am not sure we know exactly how much it costs employers.

pic of workers comp fraud miracle cure bottle
Public Domain – FDA.gov

Definition and Types

Workers Comp fraud occurs in many versions – the five I have listed are:

  1. Employer
  2. Employee
  3. Provider
  4. Claims Department -rare, but it happens
  5. Agency – usually fake agents or keeping premiums and not procuring policies

Let us look at a dictionary’s definition of fraud at the Free Dictionary.   The Free Dictionary tends to define any word or term very thoroughly.  Check out the prior link for the dictionary I surf often if I need a quick definition or a more thorough one than most online dictionaries.

A false representation of a matter of fact—whether by words or by conduct,by false or misleading allegations, or by concealment of what should have been disclosed—that deceives and is intended to deceive another so that the individual will act upon it to her or his legal injury.

Employer/Employee/Provider Workers Comp Fraud

Why do I not cover these three types of fraud? Many publications cover these three types of fraud to the nth degree.  Check out Workerscompensation.com; WorkCompCentral; Insurance Journal: and Business Insurance for in-depth coverage of fraud.

I could easily fill this website full of fraud-based articles.  Why cover what other publications cover so well?  Some of the publications I mentioned have sections devoted to fraud.

I Googled the term “workers comp fraud” just now.   Three TV stations were covering a restaurant owner in Texas who was indicted for fraud.  Businesses accused of Workers Comp fraud seem to make the news very often.

Check out these other articles from J&L on workers comp fraud.  You can click on the category in this article for a listing of all the articles.

Workers Compensation Fraud In New Jersey – Video Says It All

Workers Comp Premium Auditor Fraud Is Hard To Detect

Workers Compensation And National Insurance Crime Bureau

Insurance Buyers Swindled In Multinational Scam

Workers Comp Fraud Retraction By Adjuster – WTF?



James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management 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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