Workers' compensation fraud costs an estimated $9 billion to $34 billion annually in the U.S., with fraudulent claims often involving injuries sustained off-the-job but reported as work-related to secure benefits provided by the employer. Examples include reporting weekend injuries, such as sports accidents or home maintenance injuries, as work-related. These claims, along with exaggerating injuries or working side jobs while collecting, can lead to denied claims, fines, and criminal charges in addition to higher rates.
The over-usage and fraudulent claims of Workers Compensation insurance by employees can dramatically increase rates for business partners by affecting the company's experience modifier - which is used in rate determination.
Our specialists have expertise in the field of developing and implementing alternative risk management strategies to assist in mitigating the risk due to workers compensation usage. We will assist in determining areas of opportunity and implementing strategies to assist in modifying employee behavior for clients, potentially reducing rates.
A majority of legitimate Workers Compensation claims arise as a result of musculoskeletal (MSK) injuries. A prompt medical program of recovery can result in an expedited return to work, however, access to care providers can be limited resulting in a prolonged - and costly - claim. Our access to programs which automatically schedule care provider visits for claimants can result in a shortened recovery time and reduced claim payouts.
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