How to Fight Claims of Workers’ Compensation Fraud

At DiMarco, Araujo, and Montevideo, we want to make sure all our clients get the chance to be heard and obtain a fair deal. It takes experience, however, to know whether you’re getting a fair deal or not. Workers’ compensation cases are a good example. Many people need workers’ compensation but are afraid they’ll be accused of fraud, or that their employer or insurance companies will deal with them fraudulently. The DAM firm would like to clear up some myths regarding workers’ comp fraud.

Know the Facts

Workers’ comp fraud often happens because employers and their workers don’t know how compensation is supposed to play out. For example, the employer’s work is not done once he or she pays a worker’s comp claim. The employer must help his or her worker return to work if at all possible.

Studies show that 86% of employers have a “return to work” program, which helps ensure employees can return to their jobs at 100% pay after recovering from injuries. This is in comparison to staying on disability benefits, wherein an employee usually receives only 50-70% of normal pay. Many companies, especially smaller ones, cannot afford a return to work program, though. These companies are not committing fraud, but are likely to be accused of fraud if they don’t make some effort to help employees return to work.

Another myth workers and employers often believe is that workers’ comp medical reports are inaccurate. This often comes from bad experiences with physicians. Many physicians sign on with insurance companies to augment private practice income but hesitate to spend money on expensive equipment or diagnostic tests. Therefore, some of these physicians are more likely to treat serious injuries with ever-increasing doses of pain medication, conclude that patients are malingering, or send patients with real injuries to mental health professionals, claiming “you’re just stressed.”
For every careless physician out there, several exist who build trust with patients and file accurate reports using current medical protocol and literature. Such literature includes the AMA Guides and other regularly updated reference materials. Physicians can’t use these to “rate” impairments or say specifically when an employee can return to work; every injury and patient is different. However, they can make educated diagnoses that keep employers and their workers from being cheated out of recovery time, work hours, and wages.

Finally, some employers mistakenly believe technology will solve all workers’ comp problems. For example, it seems logical to think warehouse workers won’t slip and fall as often or get body parts caught in machines if machine and vehicle movement is computerized. Similarly, it would seem that driverless vehicles would drastically reduce or eliminate work-related traffic accidents. The truth is, however, badly used technology can cause as many injuries as traditional employment hazards. They may simply be different types of injuries.

For instance, if everything in a workplace becomes computerized, employers might see a drastic increase in back, neck, and shoulder injuries and related disabilities. If vehicles become driverless, accident rates might go up because the car itself cannot “pay attention” to the road and react to adverse conditions the way a person can. This isn’t to say businesses can’t benefit from technology, but to avoid fraud and increased claims, they should use technology wisely. Business owners should ask themselves what issues they need to solve and whether technology will do the job in the long run. If so, the technology should only be used in areas where it’s most needed.

Workers’ compensation claims can be complex. Have an experienced middle-man between you and the insurance companies. Contact the skilled attorneys at DiMarco, Araujo, and Montevideo today.