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How to Prevent Workers’ Compensation Claims Fraud

— October 4, 2022

A documented return-to-work program is one of your essential tools to prevent workers compensation insurance fraud.

There are multiple kinds of workers’ compensation fraud. Claim scams, fraud by the employer, and insurance carrier fraud are the three main types. It affects everyone. However, the truth is that it goes unreported almost daily. 

Here are some best practices that will help prevent Workers Compensation insurance fraud.

Screen your job applicants

When hiring a new employee, you should be careful. You should only hire candidates who are qualified for the job and can fit into your safety culture. Employees who are committed to your company’s mission will be more engaged at work and less inclined to play with the system.

Employers frequently conduct background checks on job applicants. Therefore, it is essential to be clear about what questions you are allowed and not permitted to ask during interviews. Specific questions and topics can expose you even if you don’t intend to discriminate.

Asking questions that reveal integrity, dedication to safety, and compliance policies can help you learn a lot more about someone. 

Encourage regular reporting by employees

Many work compensation companies have a particular unit that investigates forgery cases. Sometimes, investigators only learn about suspicious activity if a business owner or employee reports it.

Talk openly with your employees about deception. Teach your employees about  fraud warning signs. Employees should be conscious that they must report suspected fraud in their workers’ comp. They have several options if they are uncomfortable speaking with the management. They can report suspected scam anonymously to their state’s workers’ compensation carrier or the Department of Labor.

Having an open conversation about scam reporting will prevent any suspicious activity. People will be more aware of the topic, and their coworkers will likely spot suspicious behavior.

Conduct thorough investigation

Completing an incident investigation report on all injuries is essential, no matter the circumstances. Having a workplace safety program takes time to understand why an injury occurred is crucial. Understanding the root cause of an injury is the first step in preventing future ones.

An investigation can help to improve safety and uncover inconsistencies. As soon as possible, gather all relevant information. 

These are some key details:

  • Name, title, and hire date
  • Time, date, and place of incident
  • To whom and when was the happening reported
  • Intensity of injury
  • Property damage
  • Other factors that contributed to the incident

Find out as soon as possible if there are any witnesses to the incident other than the injured worker. Ask witnesses for detailed descriptions. This information should be collected from each witness individually. Each witness should provide a written statement to support documentation. You can review surveillance footage from your cameras to confirm the information you have gathered from witnesses and the worker who was hurt.

Keep in touch with injured workers

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Photo by Andrea Piacquadio from Pexels

A documented return-to-work program is one of your essential tools to prevent workers compensation insurance fraud. In addition, this program can help reduce the cost of claims, improve employee morale, and improve medical outcomes.

A successful program for returning to work involves keeping in touch. Ask them how they are doing. Take an interest in their recovery or visit them at their home or hospital. It will not only help their psychological recovery but also allows you to see any details that aren’t quite right.

Remember that work comp claims can be valid for most cases. Nobody wants to be hurt at work. But, unfortunately, your employee can get injured at work. The recovery process can be painful and prolonged. Their injury can harm their family and work performance. Your role is to help them make a plan to quickly and safely return to their everyday lives, including work.


Everyone loses when someone cheats the system, whether a business owner or an employee. It is costly to investigate and prosecute such cases. So, if you want to save billions, keep a check on fraudulent activities with the help of the right services. 

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