Taking on the Challenge of Fraud in Work Comp

December 13, 2023 • Previsor

Insurance fraud is a massive problem that costs businesses nearly $32 billion every year. While $9 billion comes from false claims, another $23 billion occurs in premium fraud. Insurance fraud is not a victimless crime. Businesses are often left paying the price for years. Watch below as Senior SIU Specialist Bill Byington explains how fraud can affect your business and what we can do together to make a difference.

What is work comp fraud? 

Work comp fraud occurs when someone willfully makes a false statement or discloses information to receive benefits or prevents someone from receiving benefits to which they may be entitled to. To prove there has been an instance of fraud, each suspected case is carefully reviewed for elements including a lie, materiality, the benefit, and if there was intent.  

Keep your business safe 

What can businesses do to protect themselves from this looming threat? First, have a strong fraud policy in place. Let your employees know that every claim will be carefully examined. If fraud is found, then there will be consequences. 

Businesses can also be proactive by investing time and resources into hiring trustworthy people. Do thorough background checks, check the internet for relevant information, and use tools like Case Net or even social media searches to learn about the people you’re bringing into your organization. 

Helping policyholders stay safe 

From a producer’s perspective, looking closely at job applications is essential.  For example, if a roofing company claims to have more clerical staff than roofers, that might raise suspicions. Scrutinizing applications can reveal potential problems and help reduce the risk of fraud. 

How we keep you safe 

At MEM, we believe it’s our duty to tackle fraud head-on. We’re not only legally obligated to fight fraud, but we also know it’s best for our policyholders. According to estimates by the National Insurance Crime Bureau, fraud costs the average American family about $900 per year, affecting not just premiums but also the overall cost of products and services. These are all reasons why MEM provides our policyholders with the value of employing our Special Investigation Unit.  

December 13, 2023
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