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| Workers Compensation Fraud |  |
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For more information either refer to the website: http://www.lni.wa.gov/ClaimsIns/FraudComp/default.asp or
contact your local
L&I field office.
There are three types of fraud or abuse the Department looks for:
Injured worker fraud or abuse.
The worker was:
- Not injured at all
- Injured somewhere besides work but claiming it was on the job,
- Doing "inappropriate activities" (one frequent example:
playing sports while supposedly too badly injured to work)
- Working a job while drawing time-loss for disability
Health care provider-fraud or abuse. A doctor
may be:
- Billing for services that weren't performed
- Billing for more expensive services than were delivered
- The one doctor people go to when they want a certain kind of
diagnosis to be able to draw workers compensation.
Employer fraud or abuse. An employer may be:
- Not reporting any or all employees to L&I and therefore
getting a "free ride" on insurance at the expense of
other employers.
- Reporting fewer hours than the employees have actually worked.
If you suspect someone is committing fraud and want to make a report
to L&I, you may call 1-888-811-5974.
A list of some "red flags"
| Claim
Fraud: Not injured at work (or not injured at all) |
| If you see someone
who … |
Then… |
- Appears to have been injured, but no one else witnessed
the accident.
- Gives conflicting stories as to how the injury occurred.
- Appears to have let a lot of time elapse between the injury
and the date they first got medical treatment.
- Appears to have sustained the injury while off work.
- Appears to have been injured immediately prior to a planned
strike or the completion of a job.
- Appears to have been injured immediately prior to or after
a disciplinary action against them.
- Appears to have been Injured immediately prior to being
terminated from their job.
- Moves out of the state or the country shortly after the
alleged injury.
- Appears to have a history of filing multiple claims.
|
Report Claim Fraud
or
Call: 1-888-811-5974
|
| Unfair
Benefits Fraud: Doing activities inappropriate for an injured
worker |
| If you see someone who appears to … |
Then… |
- Participate in recreational or other activities inconsistent
with alleged injury.
- Claim dependents not in his legal/personal custody.
- Claim a spouse when not married.
- Misuse drugs or display drug-seeking behavior (prescription
or non-prescription).
- Frequently change doctors ("doctor shopping").
|
Report
Unfair Benefits Fraud
or
Call: 1-888-811-5974
|
| Disability
Fraud: Working while on disability |
| If you see someone who appears to … |
Then… |
- Be working while on time-loss.
- Be regularly away from home during normal business hours.
- Be receiving unemployment benefits while on time-loss.
- Be working and being paid "under the table" while
receiving time-loss benefits.
- Be doing "volunteer" work while receiving time-loss
benefits.
|
Report
Disability Fraud
or
Call: 1-888-811-5974 |
| Potential Fraudulent
Activity by a Health Care Provider |
|
| IF you know a provider who… |
Then… |
- Bills for treatment on consecutive dates of service for
minor allowed conditions.
- Conducts business with the same doctor(s) and attorney(s)
that repeatedly have the same questionable claims.
- Bills for services that did not occur.
- Bills for different services than were received.
|
Report
Health Care Provider Fraud
or
Call: 1-888-811-5974 |
| Potential Fraudulent Activity
by an Employer |
|
| IF you
know an employer who… |
Then… |
- Is operating a business without the proper license or registration
and has workers.
- Pays workers in cash and doesn't give them any kind of payroll
stub.
- Gives workers a 1099 form instead of the standard W-2.
- Submits bids on jobs well below the industry standard.
- Pays workers other than in cash or check, by such things
as free rent, reimbursement of expenses, barter, etc.
- Has a large number of corporate officers listed for the
firm, and all work at the firm.
- Does not maintain or report complete and accurate employee
payroll information.
- Pays workers on a piece work basis and does not record hours.
- Requires employees to work long hours but turns in fewer
hours than they actually worked.
- Has a worker who gets injured on the job, and the employer
promises to pay the doctor and medical bills rather than report
the accident to L&I.
- Reports hours on and injured worker's accident report that
do not match the hours the employer reported to L&I.
- Has workers who find they do not qualify for unemployment
insurance because the employer under-reported their hours.
- Hires their own kids to work for the firm (other than on
a family farm).
- Has several "corporate officers" who do not exercise
control of the business operations.
|
Report
Employer Premium Fraud
or
Call: 1-888-811-5974 |
