Comments on: Fighting comp fraud: ‘Fear factor’ works http://www.hrmorning.com/fighting-comp-fraud-fear-factor-works/ Your daily dose of HR Fri, 20 Nov 2009 20:43:22 -0500 http://wordpress.org/?v=abc hourly 1 By: Hmmm http://www.hrmorning.com/fighting-comp-fraud-fear-factor-works/comment-page-1/#comment-13756 Hmmm Tue, 26 May 2009 19:50:09 +0000 http://www.hrmorning.com/?p=1911#comment-13756 Ed, I totally agree with you. A couple of years ago, I started a new HR job and the insurance company called me on day 2 and told me to sign the W/C release that they were faxing...to the tune of $45,000. Of course, I didn't and we found another insurance carrier. Ed, I totally agree with you. A couple of years ago, I started a new HR job and the insurance company called me on day 2 and told me to sign the W/C release that they were faxing…to the tune of $45,000. Of course, I didn’t and we found another insurance carrier.

]]> By: Ed Haber http://www.hrmorning.com/fighting-comp-fraud-fear-factor-works/comment-page-1/#comment-13736 Ed Haber Tue, 26 May 2009 17:25:47 +0000 http://www.hrmorning.com/?p=1911#comment-13736 My company has had four claims filed in the past year. The first was from an employee who was terminated for theft. The claim was filed one week after the termination. The second was a valid injury. The third was from an employee who filed the claim 5 months after the "injury". After a year of treatment, the doctor determined the the injury was not due to the accident. The fourth was from the same employee who claimed to have tripped over a plastic strap, no witnesses. She claimed the same injury that she claimed on the third claim. The insurance company is not always the first line of defense. In each of the disputed claims, the insurance carrier ignored our objections, as it is easier and cheaper for them to process the claim, pay whatever sum is necessary and raise the company's premiums to cover the expenses. Don't place to much faith in the insurance company to protect against fraudulent claims. My company has had four claims filed in the past year. The first was from an employee who was terminated for theft. The claim was filed one week after the termination. The second was a valid injury. The third was from an employee who filed the claim 5 months after the “injury”. After a year of treatment, the doctor determined the the injury was not due to the accident. The fourth was from the same employee who claimed to have tripped over a plastic strap, no witnesses. She claimed the same injury that she claimed on the third claim.

The insurance company is not always the first line of defense. In each of the disputed claims, the insurance carrier ignored our objections, as it is easier and cheaper for them to process the claim, pay whatever sum is necessary and raise the company’s premiums to cover the expenses.

Don’t place to much faith in the insurance company to protect against fraudulent claims.

]]> By: Chris Miller http://www.hrmorning.com/fighting-comp-fraud-fear-factor-works/comment-page-1/#comment-13039 Chris Miller Mon, 18 May 2009 12:10:58 +0000 http://www.hrmorning.com/?p=1911#comment-13039 Here is an excellent resource to help businesses spot Workers-comp fraud. From the Ohio Bureau of Workers' Compensation website (http://tinyurl.com/pekmym). Fraud red flags A red flag is a warning or a sense that something isn’t right with a claim and should lead one to take a closer look. The lists below will help employers know what to look for when identifying possible fraudulent behaviors. Identification of any one of the following red flags does not mean that fraud exists. However, in order to submit a Fraud Allegation Form to Bureau of Workers' Compensation (BWC), you need only have a suspicion that fraud may have been committed. Special agents assigned to the BWC special investigations department will carefully collect and analyze the facts to determine whether or not fraud was committed. Spotting injured worker claim fraud - Red flag indicators that may signal fraudulent activity Spotting health-care provider fraud Red flag indicators that may signal health-care provider fraudulent activity Spotting employer fraud Red flag indicators that may signal employer fraudulent activity Here is an excellent resource to help businesses spot Workers-comp fraud.

From the Ohio Bureau of Workers’ Compensation website (http://tinyurl.com/pekmym).

Fraud red flags

A red flag is a warning or a sense that something isn’t right with a claim and should lead one to take a closer look. The lists below will help employers know what to look for when identifying possible fraudulent behaviors. Identification of any one of the following red flags does not mean that fraud exists. However, in order to submit a Fraud Allegation Form to Bureau of Workers’ Compensation (BWC), you need only have a suspicion that fraud may have been committed. Special agents assigned to the BWC special investigations department will carefully collect and analyze the facts to determine whether or not fraud was committed.

Spotting injured worker claim fraud – Red flag indicators that may signal fraudulent activity

Spotting health-care provider fraud
Red flag indicators that may signal health-care provider fraudulent activity

Spotting employer fraud
Red flag indicators that may signal employer fraudulent activity

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