Worker Fraud:
Recent studies show unequivocally that 98 to 99 percent of workers’ compensation claims are for legitimately injured workers who want medical attention and returned to work. Only 1-2 percent of workers’ compensation claims are fraudulent. The total percentage of the fraud dollar that is paid to the worker is 1%. The fraud image perpetrated by the Insurance Industry and promoted by the Media is a huge, fraudulent distortion to promote their own agenda. Insurance Companies have forced benefit cuts and premium increases on the injured worker and employers alleging worker fraud, increased costs and a bad economy. Bull! A worker collecting benefits and working makes an easy target and story for the media and cover for the insurance company. Compared to Insurance Company Fraud and Provider Fraud Worker’s Fraud is a ‘drop in the bucket’ relative to the fraud committed by insurance companies in denying claims and obtaining premium. Workers’ Compensation benefits are so low by design that injured workers must return to work.
Insurance Company Fraud:
Fraud committed by insurers at the expense of injured workers represents billions of dollars. The fraud dollars in the form of denied benefits, company and insurer hacks who send injured workers back to work without care dwarf the worker’s benefits. Insurer fraud pays dividends to the carriers. That billion dollar fraud makes the back pages of the financial pages rather than the front page in a “Gotcha” Secret Camera. However, it works for the insurance company who hide their ill gotten gain of increasing premiums and reducing payment behind claims of increasing costs and worker’s fraud that are passed on to the consumer. Nine insurance companies are fined $5,000,000 for mishandling of workers’ compensation claims. The regulators refused to document the billions of dollars saved by the insurance companies cheating the injured workers. The major insurance company agreed to the fine for obvious reasons: cheating is profitable and cheaper than paying legitimate claims for the insurer even when caught. Workers’ Compensation Companies under the AIG Umbrella announced they were pleased to settle and pay the fines. The history of Unum Provident Corp and Met Life in denying legitimate workers’ claim resulted in an $84.5 Million dollar award against them in Arizona. That same company was fined $1 Million for mishandling claims practices. A surgeon was awarded $31 Million against Unum after refusing to pay long term disability benefits. In terms of dollars, the real fraud in Workers’ Compensation is committed by insurers and ends as a reward.
So, the next time you see an easy, cheap, trick by the media highlighting a worker cheating ask yourself:
“QUI BONO?” Who benefits from that charade? The worker or the insurance carrier?