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Workers’ Compensation Fraudsters: A Profile in Dirty Dealings

You probably feel as though workers’ compensation fraud is a distant problem that is not likely to affect you any time soon. In fact, most individuals and businesses feel that way—they assume that since they are honest in their dealings, that fraud is not their problem.

Workers’ compensation fraud is more common that you may think, however, and it affects you more than you know. If you are ever hurt at work, you count on your company’s coverage to protect you and pay your medical bills and lost wages. Just as uninsured motorists affect your rates and coverage for your car, workers’ compensation insurance fraud can affect the premiums that your company pays and the coverage you ultimately receive as a result.

How Companies Try to Outsmart Workers’ Compensation Insurance Carriers

Insurance coverage and premiums are determined, in every field of insurance, by measuring and predicting risk. Risk in the workers’ compensation insurance field is calculated by determining how many employees are at a company, what they do, and company history (also known as experience modification factor).

Companies have become savvy to these techniques and are notorious for underreporting the number of employees they have by classifying regular employees as contractors to seem like a smaller company. Another tricky technique they employ is to reclassify an employee’s position if their position is particularly dangerous. This would be similar to telling your auto insurance that a new Ferrari you bought is a safe family sedan—you are disguising a high-risk vehicle as a safe, low-risk vehicle to lower your premiums.

The other common insurance fraud technique companies will use involves ending their old business and reforming under a new name in an attempt to distance the company from a risky (read: expensive) history of accidents. This is known in the insurance business as experience modification evasion.

When Individuals Commit Workers’ Compensation Fraud

Not only are companies guilty of trying to outwit the workers’ compensation insurance carriers, but individuals may try to cheat the system as well. Carriers and employers alike are constantly on the lookout for possible workers’ compensation fraud, which is why it is so critical that you properly document and report your accident and injuries early in the process. While you would never consider committing fraud, having concrete evidence and documentation of your accident, medical appointments, and treatments can help your case move smoothly through the system.

You can avoid problems by immediately reporting your accident to your employer, using one of your company’s approved physicians, and making every effort to cooperate with your employer and treating physicians.

If You Encounter Resistance With Your Claim, Contact a Workers’ Compensation Attorney

While your claim is legitimate and you have been careful to follow workers’ compensation guidelines, you may still find yourself facing resistance as your claim moves through the system. If you are concerned that your claim will be denied for any reason, contacting an experienced workers’ compensation attorney as soon as possible can help you ensure that any issues are addressed quickly and efficiently.

If you have a workers’ compensation claim that has been denied, an attorney can help you gather the evidence you need to move it through the process successfully. Contact us today at Schmidt Kramer for assistance with your Pennsylvania workers’ compensation case—simply call or click on the live chat feature to connect with our firm.

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