Defending Against Fraudulent Workers’ Comp Claims

Understanding Workers’ Compensation Fraud

Workers’ compensation systems are designed to protect employees and employers by providing swift and certain compensation for workplace injuries while ensuring limited liability for employers. Unfortunately, fraudulent claims undermine this system, leading to higher costs for businesses, insurance carriers, and self-insured employers. Defending against such claims is essential to maintaining the integrity of the system and protecting financial resources.

Workers’ compensation fraud occurs when an individual knowingly misrepresents or falsifies information to receive benefits they are not entitled to. This can take many forms, such as exaggerating injuries, fabricating incidents, or continuing to collect benefits while working elsewhere. Identifying and addressing fraud early is crucial for minimizing its impact.

Common Indicators of Fraudulent Claims

• Delayed Reporting: An employee reports an injury days or weeks after it allegedly occurred.
• Inconsistent Details: The description of the incident changes or lacks clarity.
• No Witnesses: The alleged accident occurs without any witnesses or supporting evidence.
• Questionable Timing: Injuries are reported after layoffs, disciplinary actions, or after holidays or weekends.
• History of Claims: The claimant has a pattern of filing multiple workers’ compensation claims.

Strategies for Defending Against Fraudulent Claims

A proactive approach is essential for businesses and insurers to effectively defend against fraudulent workers’ compensation claims. Key strategies include:

• Thorough Investigation
  Conducting a detailed investigation of the claim is the first step in identifying potential fraud. This includes reviewing medical records, interviewing witnesses, and analyzing surveillance footage. Discrepancies or inconsistencies can provide evidence to challenge the claim.
• Utilizing Expert Resources
  Hiring medical, forensic, or vocational experts can help verify the validity of a claim. These professionals can provide objective analyses of injuries, treatment plans, and the claimant’s ability to work.
• Effective Communication
  Maintaining open communication between employers, insurers, and legal counsel ensures that all parties are informed and aligned in their approach. Regular updates and collaborative decision-making are vital to building a strong defense.
• Litigation and Advocacy
  When fraudulent claims proceed to formal hearings or court, experienced legal representation is critical. Skilled attorneys can present compelling evidence, cross-examine witnesses, and highlight inconsistencies to dispute the claim effectively.

Why Choose Robinson & Lawing for Workers’ Compensation Defense

At Robinson & Lawing, LLP, our experienced attorneys are dedicated to protecting the interests of workers’ compensation carriers, self-insured employers, and businesses. We bring a strategic approach to defending against fraudulent claims, ensuring that our clients are not unfairly burdened by illegitimate allegations.
Our team includes:

• Eleasa Harris Allen
• W. Mark Peck

With decades of combined experience in workers’ compensation defense, we provide tailored solutions and vigorous advocacy for our clients.

Partner with Robinson & Lawing to Protect Your Business

Defending against fraudulent workers’ compensation claims requires experience, diligence, and a commitment to fairness. At Robinson & Lawing, LLP, we work closely with our clients to navigate the complexities of workers’ compensation law and safeguard their resources. Contact us today to learn how we can assist with your workers’ compensation needs.