Fraud:  Frequently Asked Questions...

 

If you have a general question about "Insurance Companies" that is not answered here,  please submit it to us and we will gladly get back to you with an answer.  

What are the different types of workers' compensation fraud?

There are 3 main types of fraud within the workers' compensation industry.

 

Claimant Fraud:

This is the type of fraud that most people think of when they think of workers' compensation fraud.  An employee either fakes or exaggerates an injury.

 

Perhaps there really was an injury, but they indicate to the employer/doctor/insurance company that it was far more serious than it was so that they can stay off work or attempt to force a settlement with the insurance company.  You see them walking in to the Dr.'s office on crutches

and then on a jet ski later that day. 

 

        or

 

Perhaps there really was an injury, but it occurred over the weekend and not while they were at work.  These are both examples of fraud.

 

Medical Provider Fraud:

This occurs when medical providers deliberately over-treat a claimant or submit fraudulent bills to the insurance carrier.

 

Premium Fraud:

Employers who attempt to escape/reduce the cost of the legal purchasing of workers' compensation for their employees are committing fraud as well.  They can do this by the following methods:

 

  • Not purchasing workers' compensation, even though they know they are required by the State of Florida to do so.

  • Under reporting payrolls to reduce cost.

  • Knowingly misclassifying employees in the wrong class code to reduce cost.

  • Paying workers cash "under the table".

  • Trying to treat "employees" as "independent or sub" contractors.

 

While all types of fraud cost the system and ultimately all employers money, this is by far the largest financial impact to  the fraud equation.

What can I do if I think an employee's workers' compensation claim is not valid?

The first thing to do is to make sure you get a statement from the "injured" employee allowing them to describe, in their own words, what happened.  If there is a disagreement with what the employee "claimed" occurred and what you believe, then identify it when either calling in the First Report of Injury or in writing when mailing it in.   Be sure to include statements from any witnesses to the "accident".

 

If the disagreement is about the extent of the injury, then communicate with the insurance adjuster and explain the reasons for your disagreement. 

Where can I report an employer for not carrying workers' compensation insurance?

You can report any type of suspected fraud to:

 

State of Florida

Department of Financial Services

Bureau  of Workers' Compensation

 

Toll-Free FRAUD HOTLINE:      1-800-378-0445

                       or online at:

        WWW.MYFLORIDACFO.COM/FRAUD

 

If you desire to remain anonymous in your report, you can do so.

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Roy E. Disney

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