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Employer Fraud, Fastest Growing Issue in Compensation Insurance

BY: Rex Maldonado | Category: Others | Submitted: 2012-05-07 21:41:16
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Article Summary: "Those who are involved in worker's compensation know that the system has problems and fingers are pointed at different people. There will always be fingers pointing accusingly at all kinds of employees and employers regarding fraud..."


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Two things that all people involved in workers' compensation agree on are that the system has many problems and someone else deserves the blame. Blame is shifted from one employee and employer to another. The California Department of Insurance targets the bosses.

Employer fraud happens whenever workers' compensation insurance is being talked about. Fraud may include misclassification of employees or wrong report of payroll. The state's top insurance regulator views this in a different way.. A California insurance commissioner says that employees who are paid large amounts by their employers abuse workers' compensation insurance.

The attorney dealing with workers' compensation issues says that the blame for this current crisis can fall on any group involved. The defense of the workers would be the strongest given by him. He says the incidence of fraud by workers is miniscule. Only very few arrests and convictions took place between 1993 and 1998 out of the 4 million injuries reported, says the California applicants' attorneys association in its Web site.

It is his wish that employers and employees come to the realization that they are both in the same situation. The cost of insurance dropped five years after the deregulation of the insurance industry in 1995. The insurance companies made big profits through the investments of insurance premiums in the stock market when the number of claims went down.

Because of 9/11, the insurance industry was faced with more problems. The insurance industry and insurance companies suffered great losses because of these terrorist attacks. He wants the top 50 from the 235 private insurance companies offering workers' compensation coverage to be featured in a state Web site of California.

Another point of contention is the fact that rates are not affected when there are no claims and yet the rates go up when there are claims. Senate Bill 191 which aims to reward claim free employees is a legislation he supports.

The image of the malingering worker rings a little truer with at least one physical therapist assistant who said the term compitis is used to describe the condition of some patients in the office where he works. The recovery time for work injuries is different from the recovery for non work injuries, this gentleman says.

As an example, he cites a person who recovers faster and goes to work sooner after a softball or motor injury compared to a person who gets the same injuries in the work setting. This new and direct form of payment would encourage health care specialists not to forget their patients with workers' compensation.

Once the paperwork is accomplished, it's only a matter of time before the health specialist is sent the check by return post. He said that this is obviously different from the way an HMO works, where there are too many questions, too much paperwork, and too many costs involved.

This one chiropractor who has been practicing for 13 years claims that only 15% of his patients are on workers' compensation. He said some chiropractors do take advantage of the system, perhaps by billing for a lot more services, therapies and machines than they would normally use. He knows how the system is abused by the patients. Patients pretend they have injuries although certain tests can be done to detect malingerers.

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