Workers Comp Fraud Retraction – Where’s The Fraud?
Last week, I wrote an article on how most workers comp adjuster work had improved quite a bit over the pandemic. My heart sunk when I saw an article (thanks WorkCompCentral) this week where a workers comp adjuster fraud accusation and referral to the authorities was withdrawn due to lack of evidence. The workers comp fraud retraction seemed very unusual.
I avoid writing on Workers Comp fraud as a huge number of press outlets always ring the bell when any type of fraud whether by an employer, injured employee, medical provider, or carrier/TPA personnel. The Workers Comp “blogosphere” buzzed this week on the Workers Comp adjuster fraud retraction.
Almost 2,000 articles appear in this website, I have only written five (now six) articles on fraud.
One of the old workers comp statistics quoted often is that 3% of claims start with an element of fraud. After one year of providing benefits, the number rises tenfold to 30%.
I will not name any of the parties involved other than to say the injured employee was an up-and-coming actor. If you wish to read further, please check out this article.
One passage from the Variety that caught my eye was this quote from the county District attorney on the workers comp fraud retraction –
“After the charges were filed, the Workers Compensation Insurance claims adjuster retroactively changed his conclusion regarding her ability to work,” a D.A. spokesperson said in a statement.
There is always more to the story – so here is the original article where charges were filed.
My Experience With Workers Comp Fraud Prosecutions
My experience over the years when working on or consulting on claims adjusting nationwide is pursuing fraud on workers compensation claim resulted in an “0-for-30.” Many claim dollars and time were spent pursuing fraud with zero convictions. The charges were usually dropped as in this matter.
The Bottom Line
Should this actor have been pursued for workers comp fraud? Many developments happen over the life of a file. I cannot say the adjuster was wrong in referring the file to the authorities. Having to retract a “final decision” does not look good in print.
Without reviewing the claim file, one cannot lay the blame on any party. I do encourage reading both of the Variety articles linked to in this article and draw your own conclusions.
Related: Third Party Administrator Adjusts Workers Comp Claims For Self Insureds
