Workers' Comp Employer Fraud -- What Employees Should Know About The Problem

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When you hear the words "workers' compensation fraud," you probably picture an employee who is faking an injury for a benefit-paid vacation. Maybe you think about the guy you heard about who really was injured but kept his recovery hidden from his employer so he could work another job off the books while the benefit checks kept rolling in.

You probably don't associate the words with employer fraud -- but that may actually be a bigger problem than a few malingering employees. Here is what you need to know about the problem.

Employer Fraud Is an Overlooked Issue

Careful inquiries into the issue workers' comp fraud found that employer fraud is actually much more common than the average person believes. By comparison, people commonly believe that there's rampant workers' comp fraud among employees -- even though the actual evidence doesn't support that belief. Real fraud among employees amounts to less than 1% of all workers' comp claims.

On the other hand, employers actually have a lot more incentive to cheat the system. While an employee stands to make only a few hundred dollars a week out of fraud, an employer could net thousands in reduced premiums alone!

It Can Hurt an Injured Employee

Employers who defraud the workers' comp system don't just damage the insurance company -- they also inflict additional damage on an already injured employee by potentially depriving him or her of benefits. That's because of the various ways that employers try to evade the whole system. Some of the most common tricks employers will use include:

  • Employee misclassification, where the employer designates workers as "independent contractors" when they really are regular employees
  • Job misclassification, where the employer lies to the insurer about the type of work employees do, like designating 20 construction workers as "administrative assistants," to get a lower premium for the less-dangerous jobs
  • The use of company-preferred doctors, who make their living through the company's referrals and are thereby highly-motivated to deny care or minimize an employee's injuries to please the employer
  • The denial of valid claims, often on bogus technicalities, with the hope that employees will eventually give up

All of these are serious problems if you happen to be the employee. If you are misclassified as an independent contractor, for example, you won't be permitted to file an injury claim without first fighting to prove that you're really an employee and entitled to workers' comp benefits. 

Take Steps to Protect Yourself

If you're an injured employee, what can you do to protect yourself from employer fraud involving workers' compensation? First, don't just accept your employer's word for the fact that you aren't entitled to benefits -- for any reason. Similarly, if a company doctor downplays your injuries, don't give up. Nor should you give into an employer's pressure to keep quiet about your injuries -- even if the employer tries to pay your medical bills directly or offers you compensation off the books. That's a good sign that fraud is happening.

Talk to a workers' compensation attorney about your situation as soon as possible. An attorney will be able to tell you if you're the victim of fraud -- and show you how to get the benefits you're due despite it.