By Gary Jennings, CPCU,
ARM, ALCM, AIC, ARe, SCLA
& Forgotten Employees
This article will focus
on three types of workers’
who may commit various
degrees of “fraud,” some
of which may be due to
poor management or the
of workers’ compensation
claims management in
the current environment.
2. Opportunists, and
3. Forgotten, frustrated,
and forlorn employees.
types of fraud
These employees were
not injured at work, but
were injured elsewhere or
previously and claim the
injury occurred at work.
Some of these will not
only file multiple fraudulent workers’ compensation claims, but will also
file fraudulent automobile
or general liability claims.
I believe that the number of claims that
are outright fraud are a relatively small
percentage of the total number of claims
presented. Unfortunately, these fraudulent claims often result in payments over a
long period and result in claim payments
and loss adjustment expenses that should
not have been paid in the first place. In
my mind they also take benefits away
from employees who have truly been injured on the job and deserve the benefits.
Many think that workers’ compensation fraud is running rampant, and it may be in some areas. We see the worst cases in presentations or in media reports. However, the media
and conference speakers do not talk about the many parties involved
in workers’ compensation who act honestly and ethically within the
entire process, and who do all they can to reduce the negative impact
on the injured employees. We also do not focus as much as we should
on our own processes or execution failures that contribute to certain
categories of what some call fraud or malingering.