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Why Workers Compensation Fraud Doesn’t Pay

Ask any business owner and he or she will tell you that insurance isn’t just about property or business general, professional and employee liability coverage. In general, it is legally required for a business to purchase workers’ compensation coverage so that employees can claim benefits in the event they incur a work-related injury.

So it’s a fact: workers’ compensation is an important factor in any company’s insurance portfolio.

The problem lies when a worker files a fraudulent claim. And unfortunately, it happens quite often. But contrary to what many believe, workers’ compensation fraud does not only affect companies and bosses, and employees who go about their lives in a totally honest way, it also affects the counterfeiter. He files a false workers’ compensation claim and risks losing his job, spending time behind bars, and paying expensive fines. Trust those in the industry: crime, when it comes to workers’ compensation, sure doesn’t pay!

Below are some examples of employees who thought they could make some money by cheating the system. In the long run, the deception turned against them.

False Workers’ Compensation Claim: Real-World Scenarios

1. Marc worked as a gardener. One day, he slipped and fell at work. Marc complained of associated pain that made him unable to work any longer and filed a workers’ compensation claim. The process went smoothly and it didn’t take long for Marc to start receiving his disability benefits. However, unknown to Marc, the insurance company was on his trail. After viewing surveillance video showing Marc actively doing yard work for two other properties, Marc was called to duty. Not only would disability checks be reduced, but he was sentenced to four months in jail and ordered to pay more than $39,000 in fines.

2. Jack complained about injuries he sustained on the job. He said the resulting back pain made it impossible to continue his employment. Jack told the treating physician that he had not experienced any pain prior to the work injuries. It didn’t take long for the insurance to offer proof that Jack was lying about his inability to work. Surveillance camera caught him working as a landscaper in the family business following the claim he made, which resulted in a 3-year prison sentence and a $14,500 fine.

3. Sarah filed a workers’ compensation claim after sustaining back and leg injuries while climbing an incline at the company’s outdoor facility. When applying, she Sarah did not take into account the ability of the investigation department of the insurance company. The department’s painstaking work uncovered the true nature of the injuries: the injuries had occurred prior to the date stated on the claim, as had the conversations co-workers had with her about them. Sarah received 120 days in jail, plus 5 years probation, plus a $28,000 fine!

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