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What are My Rights as an Employer if an Employee Files a Fraudulent Workers’ Compensation Claim?

As an employer, you try to maintain a good relationship with your employees while ensuring that your company is profitable. Most employers are required to have workers’ compensation insurance to cover employees who get injured at work. Workers’ compensation provides temporary payments to employees who can’t work due to an on-the-job injury. Many employers wonder what rights they have if an employee files a fraudulent workers’ compensation claim.

What is a False Claim?

A false workers’ compensation claim is one in which the employee misrepresents their injury and tries to collect money when they should not. An employee may file a completely false claim when no injury actually occurred, or they may claim to be more seriously injured than they are. An employee may be hurt but may have done something to cause their own injury. An injured worker may try to extend their time off work and their compensation by saying that their injury is taking a long time to heal. All of these situations are considered fraud, and employers need to know how to resolve these issues.

What are Some Indications of a False Claim?

Employers should be on the lookout for some red flags that could indicate a possible fraudulent claim. Investigation of an injury is essential. If there are no witnesses to the incident or the accident was not captured on camera, it could be concerning. When an employee does not immediately report the accident or does not quickly seek medical attention, you may be concerned about the truthfulness of the injury. Another problem could be when the employee’s injury doesn’t match the report of how the accident happened. In some cases, you may find that an employee has a history of filing claims.

Preventing Workers’ Compensation Fraud

Employers should have some processes in place that will help to prevent employees from filing fraudulent claims. Conduct safety training and provide safety information to employees. Provide a method for reporting an accident or injury. Require employees to report an injury immediately. It is also helpful to give employees a method by which they can anonymously report incidents of suspected fraud. If an accident occurs, place a high priority on investigating the incident. If you feel the employee filed a false claim, report it as soon as possible.

How Employers Can Report Workers’ Comp Fraud

If, after a thorough investigation, you suspect an employee filed a fraudulent workers’ comp claim, you should discuss the matter with your attorney as soon as possible. Contact your insurance company to explain your concerns. The workers’ comp insurance company will investigate the situation. Report workers’ comp fraud to the Wisconsin Department of Workforce Development (DWD). They will investigate the claim. In Wisconsin, it is a crime to file a fraudulent insurance claim. If fraud is discovered, the matter could be turned over to the Attorney General to determine whether prosecution is appropriate.

Workers’ compensation fraud is costly to employers. If you suspect fraud by an employee, talk to an attorney to learn how to move forward. To learn more about workers’ comp claims, call us at Moen Sheehan Meyer, Ltd. at (608) 784-8310 or contact us by email to schedule a consultation.

Published May 20, 2024
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