Tag Archives: employer fraud

The Persisting Myth of Employee Worker’s Compensation Fraud

Our colleague Leonard Jernigan has compiled a list of 2012’s top 10 workers’ compensation employer insurance frauds.

It’s Holiday Season. At every gathering or party when I indicate I represent injured workers, I am asked “Aren’t most of your clients frauds?” I respond, as patiently as I can, that the actual hard data in Wisconsin, based upon years of study, indicates less than six tenths of one percent of workers have some potential element of fraud in their claims.  I further explain that the level of employer fraud makes this tiny percentage of employee fraud pale by comparison. I further note that the level of employer fraud uncovered on a daily basis is enormous.  

This routinely raises an eyebrow until the actual numbers are revealed. The questioner’s interest is also piqued when I indicate the costs of medical care and disability shifted to taxpayers through inappropriate cost shifting to Social Security, Medicare and Medicaid makes us all pay the price for employer worker’s compensation cheaters.

My friend and colleague Leonard Jernigan in North Carolina has led the difficult task of revealing these employer fraud cases and has posted the Top Ten 2012 Worker’s Comp Fraud Cases.  In 2012, the Top 10 cases alone cost nearly $100 million to the worker’s compensation system.

Included in the list are the following:

  • Florida employer creating ten “shell” companies, funneling $70 million in undeclared and undetected payroll for construction operations to avoid paying the cost of worker’s compensation coverage, leaving employees at risk.
  • Ohio companies Continue reading

Man Convicted in 2.7 Million Worker’s Comp Fraud—Not An Injured Worker

Employer fraud is far more common than worker fraud.

I read this headline in the Insurance Journal while ago. My assumption, even though I represent injured workers, was that the headline concerned an employee who had defrauded an insurance company. Why did I immediately jump to that conclusion? Because most of the headlines screaming about worker’s compensation fraud are headlines aimed at employees who are defrauding the system, even though the vast majority of worker’s compensation fraud involves employers.

The $2.7 million fraud case involved a North Carolina man, Carl Dalmus Fuller, who scammed a Florida based employment services company into purchasing a fake worker’s compensation policy. The employment company’s records showed it paid Fuller over $2.7million in premiums. The insurance company listed had no agent, and the business address was Fuller’s post office box.

Most of the headlines screaming about worker’s compensation fraud are aimed at employees who are defrauding the system, even though the vast majority of worker’s compensation fraud involves employers.

Fraud cases like this involving substantial seven-figure numbers involve insurance companies or employers who mischaracterize actual employees as Independent Contractors, miscategorize Continue reading

Wisconsin Workers Do Not Fake Injuries

I’m tired (and angry) when I read or hear news stories about alleged employee fraud in workers’ compensation cases. At cocktail parties, seminars, and social gatherings, when I say I represent injured workers, a common retort is “How many are faking their claims?” I respond, as calmly as I can, that in my experience with thousands of workers over 35 years, only a handful have not been straightforward, and that, compared to instances of employer fraud (not insuring workers, calling them “independent contractors”, telling them to file injury claims under group health insurance, etc., etc.) employee fraud is a drop in the bucket.

The Department’s six year study of such claims concluded that the public perception of workers’ compensation fraud is exaggerated. The documented level of workers’ compensation fraud is minimal.

Much fanfare (primarily fueled by insurance carrier advertisements) accompanied the mid-1990’s enactment of a fraudulent claims reporting provision in the Wisconsin Worker’s Compensation Act. Since then the statute has required insurers to report suspected fraud to the Department of Workforce Development on their own initiative and, at the request of the Department, to investigate and report on cases of alleged fraud reported to the Department by the general public.

In over 6 years, district attorneys initiated prosecution in 17 cases in Wisconsin, obtaining conviction in 14. 

Most fraud allegations are made anonymously, by telephone (608-261-8486), and from people who identify themselves as former friends or spouses, relatives, co-workers, or neighbors of the person alleged to be committing fraud. According to the Department summary report, “those allegations usually don’t pan out.” Continue reading