When Workers’ Compensation Claims Are Faked, Employers Are Harmed

Recently a viral video showed an independent contractor employee dropping ice cubes from a cup onto the floor of what appears to be a company break room. He proceeded to throw the cup away, walk towards the ice cubes, and then lower himself to the floor. He stayed there until someone came in and saw him lying on the ground. It is alleged that the independent contractor was staging a slip and fall scene in order to collect workers’ compensation. The man did follow up by filing a workers’ compensation claim and was subsequently arrested. Last month he pled not guilty to workers’ compensation insurance fraud and theft by deception.

Workers’ compensation fraud is real and does happen

Many people who shared the video on social media platforms joked about his poor acting skills, but also shared genuine feelings of disbelief that someone would be so brazen and dishonest in an effort to scam some insurance money. Los Angeles workers compensation fraud attorneys were not as surprised as others sharing this video on social media, however, because they deal with this type of employee insurance fraud on a regular basis. Employers pay for insurance policies to protect employees and provide them with compensation for on the job injuries they have sustained, but unfortunately, it is not uncommon for employees as well as medical providers to commit insurance fraud.

Operation Spinal Cap

Recently in California, an investigation known as ‘Operation Spinal Cap,’ conducted by the California Department of Insurance and several federal agencies led to an indictment of nine people who were allegedly involved in an illegal insurance scam. Those who were a part of the workers’ compensation scheme included hospital administrators and medical professionals. The scam involved medical professionals submitting approximately $80 million dollars in claims to the federal workers’ compensation program and receiving $56 million dollars in kickbacks from a hospital for referring patients to that hospital. This type of white-collar insurance scam involving hospital owners, administrators, and medical professionals is harmful to honest employers that maintain workers’ compensation benefits for their injured employees.

Workers’ compensation claimant fraud

Types of workers’ compensation claimant fraud include:

• A faked injury that never actually happened
• An exaggerated injury where the employee was actually injured, but then exaggerates the extent of those injuries to receive more workers’ compensation benefits than he or she is entitled to
• A prior injury that never fully healed claimed as a new workplace injury
• An injury that happened off of the job, but is claimed as a workplace injury
• Workers’ compensation provider fraud

Like Operation Spinal Cap, provider fraud involves medical professionals and administrators who commit insurance fraud for their own gain such as the following:

• Receiving kickbacks for referrals
• Unnecessary medical treatment and billing
• Overstating and inflating claimants’ injuries

If you believe an employee or medical provider is committing workers’ compensation fraud under your employer workers compensation policy, contact a Los Angeles workers’ compensation fraud attorney at Sacks Law Group, APC to schedule a consultation. Workers’ compensation fraud is a crime that responsible employers should not have to pay for.