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ARI Blog: Article

Fraudulent Workers Comp Scenario

We regularly like to share claims scenarios we encounter with restoration contractors. The hope is that by sharing them we can help other avoid the same type of claim.

We accidents may occur. However, when employees are involved in fraudulent claims it hurts entire communities, especially an employer, whose workers compensation insurance premiums increase due to the loss.

At ARI we are dedicated to protecting policyholders by combating fraud. Below is a story of a win in the battle against workers compensation fraud:

Sam was a laborer for a restoration contractor who felt he should only work when he wanted to. Before starting his shift on a Friday evening he devised a plan to skip work and still be paid.

Early in his shift he paced up and down the aisle in the back warehouse watching his co-workers. Once he realized his coworker was distracted he walked over to a wire rack and shook it to see if it would fall.

Realizing no one was watching he pulled the wire rack down on himself and started screaming for help. Eventually, an ambulance was called to transport him to the hospital.

What Sam did not realize was the company had video cameras in the back warehouse. His staged accident was caught on video tape.

Sam faces up to 5 years in prison for workers compensation fraud if convicted by a court of law.

Some potential fraud red flags to be on the lookout for include:

  • The employee has injuries that do not match with the story of the accident

  • There are no witnesses to the accident

  • The accident occurred early on a Monday morning or after a holiday weekend

  • The accident leads to rumors or whispers around the workplace that the injury was faked.

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