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Types of Workers’ Compensation Fraud


Insurance companies often hire investigators to gather more information and evidence about a particular case after a workplace accident. In addition to doing this to try to negate the validity of even the most legitimate workers’ compensation claim to minimize costs, investigations also occur so often because workers’ compensation fraud unfortunately occurs. The last thing any worker with a legitimate claim needs is to inadvertently show behavior that would appear to fall within one of the types of workers’ compensation fraud.

Understanding the Benefits of Workers’ Compensation

Under Florida law as in many other states, most businesses that operate within the state are required to carry workers’ compensation insurance. Millions of net premiums are written every year. This system is in place to cover the cost of medical care, prescription medicines, and related physical therapy and rehabilitation for injured workers. It is also intended to provide death benefits for the surviving family members of those who are killed in work-related accidents. As obtaining these benefits does not require a showing of fault, pursuing them is sometimes tempting even to those who are not forthcoming about the genuine nature of their injuries.

Types of Fraud  

It is of course true that workers sometimes falsely assert that an injury or illness is work-related in an attempt to acquire workers’ compensation benefits. And even when an employee genuinely gets hurt at work, there is still the potential for workers’ compensation insurance fraud to occur. Regardless of how it occurs, workers’ compensation fraud can lead to serious problems for the worker and have other implications. The National Insurance Crime Bureau reports workers’ compensation fraud costs companies of all sizes about $7.2 billion annually, or 20 percent of all workers’ compensation payments.

Situations that are considered to be fraud can include:

  • False claims. Workers sometimes make up injuries that don’t exist or become injured only because they deliberately stage the workplace for the accident in an attempt to collect benefits.
  • Being deceptive about the extent of the injuries. In some cases, a work-related accident genuinely occurs but the situation still becomes fraudulent when the worker exaggerates the extent of the injuries.
  • Presenting unrelated injuries as related. There are also situations where a worker has a genuine injury or disease, but their condition is not actually related to their workplace as he or she was injured away from the job site.

It is imperative that every worker understand these various types of fraud. This is an important first step in learning what appearances should be avoided.

Are You Concerned With Making Sure You Take the Appropriate Steps?  

With everything going on in the world these days, it is even more essential than it would normally be to have an experienced attorney on your side who can help you undertake the appropriate steps to maximize your chances of success. As the Miami workers’ compensation attorneys at Payer & Associates, we have fought for the rights of our clients in a wide variety of serious workers’ compensation cases. You can depend on us to guide you throughout every step of the process as we put our knowledge and experience to work for you. Contact us today to begin.


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