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REPORT SUGGESTS WAYS TO KEEP CLAIMANTS HONEST

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WASHINGTON-Printing anti-fraud warnings on the back of wage-loss checks is one step workers compensation payers can take to battle fraud, a national coalition recommends.

That tip is among the recommendations in a recent report issued by the Workers Compensation Task Force of the Washington-based Coalition Against Insurance Fraud, titled "Workers Compensation Fraud-Public Policy Issues for the Future."

The coalition, which includes consumer, government and insurer representatives, developed the recommendations after finding that workers comp judges often lack the authority to discipline fraudulent parties and that prosecutors have difficulty proving intent to defraud.

In addition, many insurance companies and state agencies lack the expertise to investigate workers comp fraud, the coalition found.

Among the tips for fraud fighters:

Print a warning on the back of wage-loss checks sent to some recuperating workers.

Such a warning could read: "If this draft is for Temporary Total or Temporary Partial Disability Benefits, you must advise your employer and the insurer of any of the earnings you may be receiving or work activity you are engaged in, while receiving these benefits. Failure to do so may result in civil and/or criminal liability."

Anecdotal evidence suggests such warnings may help deter fraudulent claimants from cashing checks, the report said. In addition, the warnings may "provide useful evidence of criminal intent when claimants knowingly sign and cash the checks when they have side jobs or other illegal sources of income," according to the report.

Lobby states to give workers compensation judges more powers. These include the ability to order restitution for victims of fraud, hold perpetrators in contempt for perjury and refer medical providers for disciplinary actions.

Sponsor educational programs for employers so they can learn how to combat claims fraud and identify fraudulent insurance providers.

Research evolving fraud issues in managed workers comp care settings.

Urge state lawmakers to enact the coalition's model insurance fraud act.

The coalition's model act encompasses all forms of insurance, including workers comp insurance. It would create broad criminal and civil sanctions against perpetrators of fraud, provide restitution for victims and sanction providers convicted of fraud. It also includes immunity provisions that would encourage fraud reporting and cooperation with law enforcement agencies.

Five states have adopted at least some portion of the coalition's model act: Colorado, Michigan, Minnesota, Tennessee and Wisconsin.

Similar bills are pending in seven states: Arkansas, Nevada, New Mexico, Oklahoma, Oregon, South Dakota and Virginia.

"We are encouraged by the amount of legislative action so early in the season," said Dennis Jay, the coalition's executive director.

Enact model legislation proposed by the National Assn. of Insurance Commissioners governing employee leasing arrangements.

That model would give states and insurers additional tools to make sure businesses are not using employee leasing arrangements to avoid paying appropriate workers comp premiums, the report said.

The recommendations accompanied three key findings by the coalition:

Workers comp judges in most states lack the authority to discipline defrauders.

"In even blatant attempts to defraud by claimants, attorneys and medical providers, the only option usually available to the judge is to deny eligibility for further benefits," the report said.

Prosecutors often are stymied with claims fraud cases because of the difficulty in proving intent to defraud, which is the legal standard for criminal conviction, the report said.

"In other forms of insurance, intent to defraud is often supported by claims forms and other documents claimants sign to attest to the validity of their claims. However, because of the no-fault nature of workers comp, claimants usually do not sign any document in order to receive or continue receiving benefits," the coalition said.

Insurers and state agencies often lack the ability to battle fraud.

"Many insurers, state plans and law enforcement agencies lack the expertise to investigate premium fraud and prepare cases for prosecution" because such cases "often are highly complex with long paper trails reminiscent of a federal tax audit," the report said.

Single copies of "Workers Compensation Fraud: Public Policy Issues for the Future" are available free. Contact the coalition at 1511 K St. N.W., Suite 622, Washington, D.C. 20005; 202-393-7330.