Help your policyholders fight workers’ compensation fraud and abuse

Workers’ compensation fraud occurs when an employee falsifies information to obtain benefits they don’t deserve or aren’t eligible to receive. Workers’ compensation abuse occurs when a person interferes with the adjustment of a claim. Fraud and abuse can wreak havoc on your policyholders’ businesses. In fact, workers’ compensation fraud is the second most common white-collar crime in the U.S.

In 2016, the Association of Certified Fraud Examiners (ACFE) found that a single case of fraud cost business owners a median amount of $150,000, with more than 23 percent of occupational fraud cases amounting in the loss of more than $1 million. The ACFE also found that the typical organization loses 5 percent of its annual revenues to fraud.

You can help prevent your policyholders from becoming victims of fraud by making them aware of these signs:

• An injury that springs up on a Monday morning or any window of time following an employee’s personal time off
• Injuries reported immediately before or after a termination, layoff or strike
• Injuries reported during a strange time, such as lunch, a break or when the employee was in an area where he or she shouldn’t have been
• No witnesses to the injury, inconsistencies in the description of what happened or unwillingness from the employee to provide information

Our Special Investigations Unit (SIU) at BrickStreet will thoroughly examine reports of suspected fraud and abuse. This dedicated team takes each allegation seriously, works diligently to evaluate each accusation fairly and will maintain confidentiality and/or anonymity for all parties involved to the fullest extent of the law. They also can host training programs to help policyholders spot workers’ compensation abuse and fraud.

Encourage your policyholders to report workers’ compensation fraud or abuse if they suspect it. To report suspected fraud, call 866-926-3469 or email reportfraud@brickstreet.com.