Workers' Compensation

Preventing Fraudulent Claims

Chelsea Bikner
Preventing Fraudulent Claims
Reading time 3 Mins
Published on Nov 13
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Workers’ compensation fraud costs American employers billions of dollars each year. You want to protect the health and well-being of your employees, especially when they’ve been injured in the workplace. Preventing fraudulent claims allows you, the Ohio Bureau of Workers’ Compensation, and your Ohio third party administrator (TPA) to focus on keeping unnecessary claims costs under control. Read on to learn more about how you can help prevent fraudulent workers’ compensation claims.

Create a fraud-free work environment

The key step you can take to avoid workers’ compensation fraud is to institute and uphold a fraud-free work environment and implement a strong anti-fraud policy. Not only will you encourage employees to be vigilant and report potential fraud, but it will also discourage employees from attempting to commit fraud.

Establish a reporting process that allows employees and supervisors to report any suspected fraud. While you should never directly confront someone suspected of making a fraudulent claim, you should take all reports seriously and report them to your TPA and the BWC immediately.

The same reporting and investigating process should be used for all accidents and documentation should be kept for all reported injuries. Interview injured employees and witnesses of the incident. Ask for written statements and forward them to your TPA.

Rethink your hiring procedures

Your hiring procedures can be another line of defense in preventing workers’ compensation fraud. Screen potential employees and perform appropriate background checks to determine if they’ve made fraudulent claims in the past. Implement pre-employment drug screening policies and require a drug screening any time that an accident occurs to ensure that the injured person wasn’t using illicit substances at the time of the incident.

Maintain contact with injured employees

Show your injured employee that you value their contribution to the workplace and that you care about their recovery by maintaining contact with them during their recovery period. This step can also help encourage early return to work since the employee knows that their recovery progress is being monitored.

Watch out for fraud

If you have a security system in your workplace, it can perform double duty in helping to prevent workers’ compensation fraud. You can review any workplace incidents that result in injury and share the footage with your TPA and the BWC. The presence of cameras can also discourage employees who may consider making a fraudulent claim.

Spotting and preventing fraudulent claims

Most employees are honest and hardworking, but the small percentage of workers who commit fraud increase the costs of workers’ compensation for everyone and cause increased scrutiny even on legitimate claims. With early intervention and the establishment of preventative policies and procedures, preventing fraudulent claims in the workplace is possible. With a TPA partner like Sheakley UniService, you can learn more about identifying and preventing workers’ compensation fraud.

Stay up-to-date on all things Sheakley by subscribing to our blog and following us on social media. What are you doing when it comes to preventing fraudulent claims in the workplace? Join in the discussion by commenting below.


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