When it Comes to Fraud, the Price is Never Right

Handcuff FraudA North Carolina postal worker claimed a job-related injury prevented her from lifting boxes of mail. Her workers’ comp insurer began paying benefits to her.

Meanwhile, the insurer discovered the woman was a contestant on the “Price is Right.” Her injuries did not prevent her from spinning the giant prize wheel not just once, but twice.

The woman was also spotted lifting furniture, carrying groceries and even ziplining on a cruise. She is set to be sentenced for workers’ comp fraud in September.

Cases such as these are the exception. Most injuries are legitimate, and most claimants genuinely want to recover and return to work. But sometimes, people cheat the system.

Fraud costs the workers’ compensation system approximately $7 billion a year, according to the National Insurance Crime Bureau. Those costs trickle down to everyone in the form of higher premiums.

Fraud is lying for financial gain. Anyone who has a stake in the workers’ comp system can commit fraud, but claimant fraud is the most common type of fraud. Claimant fraud happens when workers:

  • Fake or exaggerate injuries
  • Collect benefits for injuries that were not work-related
  • Double-dip, or continue to collect benefits after returning to work
  • Engage in activities that are inconsistent with their injuries

Insurers have a vested interest in identifying and stopping fraud. In fact, Texas Mutual maintains three teams of in-house fraud investigators.

Still, fighting fraud requires a coordinated effort among all stakeholders. Employers can help if they learn to recognize the warning signs of claimant fraud. If you identify two or more of these red flags in a claim, contact your insurer immediately. You can also report your concerns to the Texas Department of Insurance fraud unit:

  • Tip from a credible source
  • New or disgruntled worker
  • No witness to alleged injury
  • Inconsistent or illogical description of incident
  • Hard to contact injured worker
  • Injured worker acts upset when contacted
  • Suspicious injury on Monday or Friday

 If your insurer opens and investigation, it will need your cooperation. Provide access to witnesses, attend hearings and notify the investigator if you discover new information.

 Together, we can win the fight against fraud one case at a time.

Final Thoughts From 2013 AASCIF Annual Conference

Erik Qualman, author of the best-selling book, "Socialnomics: How social media transforms the way we live and do business," address the crowd during the AASCIF Annual Conference in Austin.

Erik Qualman, author of the best-selling book, “Socialnomics: How social media transforms the way we live and do business,” addresses the crowd during the AASCIF Annual Conference in Austin.

In new media circles, he’s known as the “Digital Dale Carnegie,” a Top 100 Digital Influencer and the man behind the longest-running podcast in the world. Erik Qualman also happens to be a gifted speaker who has appeared with the likes of Al Gore, Sarah Palin, Julie Andrews and skateboarder-turned-entrepreneur Tony Hawk.

In July, the stage was all Qualman’s during the AASCIF Annual Conference in Austin. Clearly as comfortable face-to-face as he is in cyberspace, Qualman explained  to a banquet hall full of AASCIF members how social media and the pace of technology are changing the way we do business.

Qualman was one of several prominent speakers featured during the conference. The line-up included Joe Paduda, author of the controversial “Managed Care Matters” blog. Paduda discussed the future of workers’ compensation and what industry leaders are (and should be) concerned about.

Closing out the week’s presentations was Lee Cockerell, who spent his career delivering extraordinary customer experiences in the hospitality industry. Cockerell worked 17 years in executive positions with the Marriott Corporation and eight years with Hilton Hotels. He retired from Disney as executive vice president of operations.

 Cockerell shares his customer service best practices in his books, “The 39 Essential Rules for Delivering Sensational Service,” and “Creating Magic…10 Common Sense Leadership Strategies From a Life at Disney,” as well as on his apps, “Creating Magic Leadership” and “Coaching On The Go.”

Texas Mutual thanks all of our speakers for sharing their expertise with AASCIF members. If you want to learn more about Qualman, Paduda, Cockerell and our other speakers, visit them online:

Thom Singer is an expert in social networking and developing a personal brand. Visit him at http://www.thomsinger.com and thomsinger.blogspot.com.

Joe Navarro spent 25 years in the FBI, working as an agent and supervisor in the areas of counterintelligence and counterterrorism. Through his work, he studied, refined and applied the science of non-verbal communication. Visit him at jnforensics.com.

Jana Owen has traveled the country as one of Freedom Personal Development’s top speakers and coaches. Whether it’s her programs on memory training, time management, entrepreneurial DNA or goal setting, Jana brings an intensity to her presentations that calls clients to action. Visit her at janaowen.com.

Joe Paduda is Principal of Health Strategy Associates and author of the popular weblog “Managed Care Matters,” which attracts more than 1,500 unique visitors per day. Visit him at joepaduda.com.

Erik Qualman is an MBA professor at the Hult International Business School and author of “Socialnomics: How social media transforms the way we live and do business.” Visit him at http://www.socialnomics.net.

Lee Cockerell is the man behind “Disney Great Leader Strategies,” which is the primary resource for developing the 7,000 leaders at Walt Disney World. Visit him at leecockerell.com/di.cfm and blog.leecockerell.com.

Media coverage

Special thanks to the bloggers and writers who reported on our conference:

Joe Paduda – http://www.joepaduda.com/2013/07/aascif-report-annual-conference/

Robert Wilson of workers’ compensation.com – http://www.workerscompensation.com/compnewsnetwork/from-bobs-cluttered-desk/17072-aascif-2013-is-about-communication-branding-and-building-a-better-you.html

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