Worker’s Comp Fraud

We represent Indiana workers injured on the job through the state’s worker’s compensation system, including appeals through the court system. We don’t represent people who engage in fraud to either invent a work-related injury or to make it appear the injury is worse than it is. If you’re tempted to engage in fraud in the hopes of making a quick buck, don’t bother. The risks far outweigh the potential benefits.

If you engaged in fraud when filing for worker’s compensation in Indiana, you would be committing a crime; depending on the circumstances, it could be a Level 5 felony (prison term of from one to six years) or a class A misdemeanor (up to 60 days in jail and a $500 fine). Anyone believed to be engaging in worker’s compensation fraud will probably be fired, too, making finding another job that much more difficult.

Indiana Worker’s Compensation Fraud May Cover a Large Share of All Claims Filed.

The Travelers Insurance Co. estimates that all insurance fraud cost insurers about $30 billion annually, with about a quarter of it, or $7.2 billion a year, coming from worker’s compensation fraud, according to the National Insurance Crime Bureau (NICB). The NICB claims worker’s comp fraud is the fastest growing type of insurance fraud. This fraud drives up the cost of worker’s compensation insurance premiums, which are ultimately passed on to consumers and taxpayers.

Worker’s compensation fraud is generally perpetrated by employers, medical providers and employees.

  • Employers commit fraud by reporting fewer employees than they have or misclassifying them into less hazardous positions to try to lower the premium.
  • Medical or service fraud happens when a healthcare provider “upcodes” (or bills for procedures or treatments not actually provided or makes a diagnosis more serious than what the worker actually suffers) or provides more medical treatment than what is actually needed.
  • Employee or claimant fraud includes claims for injuries that happen outside work, were staged in the workplace or falsely prolonged to get benefits the person wouldn’t be entitled to receive.

Travelers estimates about 20% of all worker’s compensation claims involve employee fraud.

Some Might Think Fraudulent Indiana Worker’s Compensation Claims Are Not a Big Deal.

Surveys by Insurance Research Council (IRC) and Progressive Insurance show that many people don’t have a problem with committing insurance fraud.

  • 35% stated it was OK to file an insurance claim higher than the actual loss.
  • About 34% said it was “almost always acceptable” to not work if they had some pain, even though they were medically cleared to return to work.
  • 5% stated it was acceptable to get worker’’ comp benefits for injuries that happened at home, collect benefits even if they fully recovered or work another job while collecting benefits.
  • About 21% stated they knew of worker’s compensation fraud schemes at work.

Fraudulent Indiana worker’s compensation claims may be found at different stages of the process.

There are many ways an employer can try to find worker’s compensation fraud, including,

  • Handling all injury reports, including possibly fraudulent ones, through an investigation process, including talking to witnesses and documenting all reported injuries
  • Having an internal fraud reporting system where people can report suspected fraud. A report could eventually result in criminal prosecution.

Once a worker’s comp claim is filed, an investigation by the insurance company or its attorneys will take place. Their job is to try to find fraudulent claims; while trying to do so, legitimate ones are often called into question. Employees who engage in fraud just make the worker’s compensation system that much more difficult for those truly injured at work.

  • One popular way to try to find fraudulent claims is to review social media posts of claimants. If photos, videos or posts provide evidence of another explanation for the injury or show that the limitations are not as bad as claimed, a claimant could be accused of fraud.
  • Claimants could also be physically followed, their actions video-recorded and people they know questioned about the claimant’s health and activities.

We also investigate our clients’ injury claims. If we believe someone is engaging in fraud, we will discuss the situation with them; if we believe the person is not being honest with us or their employer, we will not represent them. We have worked too hard, for too long, to earn our stellar professional reputation — and we won’t let someone seeking our help jeopardize it.

If after reporting your injury to your employer you learn the company is engaging in worker’s compensation fraud, or doesn’t have any worker’s compensation insurance, contact our office. If your employer is involved in fraud, you may be unable to file a worker’s comp claim, but you may be able to file a lawsuit through the court system instead.

We refer our clients to the best doctors in their fields in the area. They are honest and forthcoming not only to their patients but to insurance companies as well. We will not work with medical professionals who may be engaging in fraud. Those that do should be avoided, because not only may they be dishonest with an insurance company, they may not be telling you the truth either — and you may be going through treatment that you don’t need which may actually be harmful.

Every year, thousands of Indiana workers are legitimately injured in their workplace. Our firm has helped many clients in worker’s compensation disputes. Contact us today to learn more about how we can help you, too.