Workers Compensation Fraud

Topics: Workers' compensation, Insurance, Employment Pages: 6 (1806 words) Published: January 17, 2011
In 1939, Edwin Sutherland coined the term “White Collar Crime.” The term originally characterized white-collar criminals as those with respectability and high social status who carried out crime during “his” occupation. Today, the definition of white-collar crime has been expanded to include much more than “upper class criminals.” White Collar Crime can be defined as “an offense carried out by non-coercive, nonviolent means, and using or utilizing an acquired skill or technology to perpetuate a fraudulent scheme” (Rosoff 15). One particular form of White Collar Crime is worker’s compensation fraud. One example of workers’ compensation fraud was reported on by ABC News and involved Bruce Gilbert, a bus driver who “talked like a five year old, a problem his wife blamed on an ‘on-the-job’ accident” (Hunter). Gilbert’s wife claimed that her husband suffered from a “regressive mental ailment that effectively gave him the mental capacity of a child of about five” (Hunter). Over the course of 10 years, the Gilberts received approximately $774,000 in workers’ compensation. A private investigator, however, found that not only was Bruce Gilbert still able to drive, but he was also able to hunt and golf as well. In April of 2000, he was arrested for workers’ compensation fraud and grand theft. His wife was also arrested. The two each received 15 years of probation and had to pay back all of the money they received from the workers’ compensation. Since our research, the Gilberts have only paid back $4000. Sadly, this is only one case out of many that exist. Worker’s compensation fraud or claimant fraud has been a growing problem since the late 1980s. “Claimant fraud happens when employees knowingly lie to collect benefits. They may claim an injury was work-related when it wasn’t, exaggerate an injury, or secretly continue working while collecting benefits” (Wylie). Claimant fraud costs the nation approximately $31 billion dollars a year. It is estimated that about 10% of all claims involve some sort of fraud or benefit abuse. Due to this rampant fraud, numerous states have passed legislation against claimant fraud. Before claimant fraud can be proved, however, businesses must first know the myths and signs of worker’s compensation fraud and be able to prove it. If an individual files a claim, several red flags should appear. According to Automatic Data Processing Incorporated (ADP), if an individual has a history of filing workers’ compensation claims we need to report the accident date, nature of the injury, the type of accident as well as the part of the body that was injured. Businesses should also look at the award/compensation and the total amount that was paid. Also, if your business uses workers’ compensation searches, there are several important compliance considerations and responsibilities. Also, the ADA Act (Americans with Disabilities Act) allows you to order workers’ compensation records, and governs how you are able to use the medical and disability information during a company’s hiring process. ADP’s Human Resource help desk professionals put together a list of warning signs that businesses should be aware of when dealing with workers’ compensation. The first sign is if no one witnessed the injury other than the employee filing the workers’ compensation claim. The second sign is if the injury occurred late Friday or early Monday. The third sign is if the injury was not reported until a week or more after it had allegedly occurred. The fourth sign is if the employee received an injury that had occurred a day before a strike or holiday, or anticipation of termination. The fifth sign is if the injury occurred in a location where the employee does not normally work. The sixth sign is if the injury was inconsistent with the employee’s normal job duties. The seventh sign is if others see the employee engaged in activities that should not be possible due to his or her reported injury. The eighth sign is if...
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