Detecting and Preventing Workers Compensation Fraud
By Ranney Pageler Vice President of Fraud Investigations, EMPLOYERS | March 06, 2016
Hotels can be ripe environments for workplace injuries, which is why hotel owners and managers need to be able to distinguish between legitimate work-related injuries and potentially fraudulent attempts to claim workers' compensation insurance benefits. To protect their businesses, hotel owners and managers need to understand the types of workers' compensation fraud as well as the red flag indicators that could signal a fraudulent claim.
Even when safety is a priority, hotel workers are at risk of being injured at work. For instance, kitchen staff often work around slippery surfaces, hot liquids and sharp objects. Housekeeping staff are subject to strains caused by repetitive motions. Hotel porters are often required to do a lot of heavy lifting.
With these inherent risks, it is not surprising the leisure and hospitality industry saw 327,400 non-fatal workplace injuries in 2014 according to the U.S. Bureau of Labor Statistics1. Since the industry experiences such a large number of workplace injuries, hotel owners and managers need to be able to distinguish between legitimate work-related injuries and potentially fraudulent attempts to claim workers' compensation insurance benefits.
Workers' compensation insurance is designed to protect employers and their greatest assets, their employees, should an on-the-job injury or illness occur. While rules and plans differ among states, in general, workers' compensation benefits can include weekly payments in place of wages and payment of related medical expenses.
Unfortunately, sometimes dishonest workers may attempt to take advantage of this system by filing fraudulent claims. The two types of workers' compensation fraud that can directly impact businesses are claim-related fraud and policy-related fraud. Both are serious crimes and both can potentially cripple a business if not detected.
Claim-Related Workers' Compensation Insurance Fraud