False Claims Act
 
Not all claims made for work accidents and injuries are considered legitimate claims. In fact, a lot of these have been deemed false claims, with people filing for worker’s compensation even when they are not eligible for it. Claims made for compensation when a person is not entitled to it is covered by the False Claims Act, and as such, are punishable by law.

The False Claims Act actually covers a lot of different scenarios. By definition, it is the act of falsely billing, over-representing a delivered product, and knowingly presenting a false claim for payment. It is also defined as knowingly using, making, or having others make or use a false statement or record to pursue a false claim.

When it comes to the False Claims Act, a number of scenarios are possible. It can include healthcare fraud, Medicare kickbacks, and other similar violations. When it comes to making a false claim on worker’s compensation for work accidents and injuries, these are usually made by those who want to claim more for injuries that actually do not exist.
 

What Counts as a False Claim for Work Accidents and Injuries

There are many different kinds of false claims that belong to this category. Most of these involve individuals who purposely lie about their condition in order to get more compensation for a minor or non-existent injury.

When a false claim is made by an employee for compensation even when they are not entitled to it, it is deemed a felony. It is called worker’s compensation fraud when worker’s comp is claimed by someone who is not eligible for it. Here are some examples of what some people do that can be considered a false claim:

Claiming a Work Injury That Actually Happened Off the Job – This can be easily determined by when the person files the injury claim. If a person files this claim on a Monday, stating the injury happened on Friday, there is a huge possibility that the person got injured over the weekend, while they were not working.

Malingering – This is what a lot of people do to get paid for a job they are not doing even when they are actually well enough to go back to work. Pretending to still be injured or sick, just to extend down-time while still receiving compensation, is also considered fraud.

Using an Old Injury as If It Was a New One – Using an old football injury that the company does not know about or a damaged shoulder that never healed properly as a new injury in order to claim worker’s compensation is also fraud.

Fake Injuries – A lot of the fake injuries that are used by people to claim compensation for are usually those that are rather hard to disprove. These include soft-tissue injuries, migraines, headaches, and other similar complaints.

Exaggerating Injuries – Some people tend to claim that an injury is more serious than it actually is. This is in order for them to get some free time off and get paid for it even though they are not entitled to such a privilege. For instance, a worker may claim to suffer from agonizing back pain and difficulty in walking after slipping on a wet spot at work. Yet, when they are visited at home, they are actually walking just fine and not exhibiting any signs of the injuries that they claim to have.
 

Why People Make False Claims

There are many reasons why people make false claims when it comes to work accidents and injuries. Here are some of the most common ones:

Downtime – People who fake their injuries or inflate them to appear more serious than they actually are, often do so in order to get some downtime while at the same time get paid for it. Call it a free “vacation” with pay.

Make Extra Money – Another reason why people try to defraud their company by claiming worker’s compensation is in order to make extra money. This can come in the form of other work that they do while they are still being paid by the company for their “injury”.

They Need a Huge Amount of Money Fast – People can get mired in debt for many different reasons. Some get in so deep because of bad habits while others simply live above their means. People use fake injuries, old injuries, or exaggerated injuries to get money to pay off these debts. This happens when a person claims a permanent disability or impairment due to their work injury. This entitles them to a lump sum. This is usually done in cahoots with a medical practitioner who confirms the disability, even if it is not real, in exchange for a part of the settlement.
 

What to Do When You Suspect a False Claim

Companies can easily detect false claims being made for work accidents and injuries with the help of a few telltale signs. For example, if a worker claims an injury happened on Friday but made the report about it on Monday. This can denote that the accident actually happened over the weekend and not during work hours.

Another example of possible false claims for worker’s compensation due to work accidents and injuries is when a worker claims an accident happened but there are no witnesses. While this is possible, most companies have more than one person in an area at any given time. This can be prevented with the use of security cameras in all areas of your facility.

No matter what the circumstance or how the claim was made, when you suspect a false claim is being made, an investigation may be in order. You will need to find out whether or not your company has been victimized by someone committing fraud and if you can get back the compensation that you have already awarded them.

In order to do this, take a quick look at our questionnaire. Answering these questions can give you some insight on whether or not you are the victim of a false claim.

 

False Claims Act
 
Not all claims made for work accidents and injuries are considered legitimate claims. In fact, a lot of these have been deemed false claims, with people filing for worker’s compensation even when they are not eligible for it. Claims made for compensation when a person is not entitled to it is covered by the False Claims Act, and as such, are punishable by law.

The False Claims Act actually covers a lot of different scenarios. By definition, it is the act of falsely billing, over-representing a delivered product, and knowingly presenting a false claim for payment. It is also defined as knowingly using, making, or having others make or use a false statement or record to pursue a false claim.

When it comes to the False Claims Act, a number of scenarios are possible. It can include healthcare fraud, Medicare kickbacks, and other similar violations. When it comes to making a false claim on worker’s compensation for work accidents and injuries, these are usually made by those who want to claim more for injuries that actually do not exist.
 

What Counts as a False Claim for Work Accidents and Injuries

There are many different kinds of false claims that belong to this category. Most of these involve individuals who purposely lie about their condition in order to get more compensation for a minor or non-existent injury.

When a false claim is made by an employee for compensation even when they are not entitled to it, it is deemed a felony. It is called worker’s compensation fraud when worker’s comp is claimed by someone who is not eligible for it. Here are some examples of what some people do that can be considered a false claim:

Claiming a Work Injury That Actually Happened Off the Job – This can be easily determined by when the person files the injury claim. If a person files this claim on a Monday, stating the injury happened on Friday, there is a huge possibility that the person got injured over the weekend, while they were not working.

Malingering – This is what a lot of people do to get paid for a job they are not doing even when they are actually well enough to go back to work. Pretending to still be injured or sick, just to extend down-time while still receiving compensation, is also considered fraud.

Using an Old Injury as If It Was a New One – Using an old football injury that the company does not know about or a damaged shoulder that never healed properly as a new injury in order to claim worker’s compensation is also fraud.

Fake Injuries – A lot of the fake injuries that are used by people to claim compensation for are usually those that are rather hard to disprove. These include soft-tissue injuries, migraines, headaches, and other similar complaints.

Exaggerating Injuries – Some people tend to claim that an injury is more serious than it actually is. This is in order for them to get some free time off and get paid for it even though they are not entitled to such a privilege. For instance, a worker may claim to suffer from agonizing back pain and difficulty in walking after slipping on a wet spot at work. Yet, when they are visited at home, they are actually walking just fine and not exhibiting any signs of the injuries that they claim to have.
 

Why People Make False Claims

There are many reasons why people make false claims when it comes to work accidents and injuries. Here are some of the most common ones:

Downtime – People who fake their injuries or inflate them to appear more serious than they actually are, often do so in order to get some downtime while at the same time get paid for it. Call it a free “vacation” with pay.

Make Extra Money – Another reason why people try to defraud their company by claiming worker’s compensation is in order to make extra money. This can come in the form of other work that they do while they are still being paid by the company for their “injury”.

They Need a Huge Amount of Money Fast – People can get mired in debt for many different reasons. Some get in so deep because of bad habits while others simply live above their means. People use fake injuries, old injuries, or exaggerated injuries to get money to pay off these debts. This happens when a person claims a permanent disability or impairment due to their work injury. This entitles them to a lump sum. This is usually done in cahoots with a medical practitioner who confirms the disability, even if it is not real, in exchange for a part of the settlement.
 

What to Do When You Suspect a False Claim

Companies can easily detect false claims being made for work accidents and injuries with the help of a few telltale signs. For example, if a worker claims an injury happened on Friday but made the report about it on Monday. This can denote that the accident actually happened over the weekend and not during work hours.

Another example of possible false claims for worker’s compensation due to work accidents and injuries is when a worker claims an accident happened but there are no witnesses. While this is possible, most companies have more than one person in an area at any given time. This can be prevented with the use of security cameras in all areas of your facility.

No matter what the circumstance or how the claim was made, when you suspect a false claim is being made, an investigation may be in order. You will need to find out whether or not your company has been victimized by someone committing fraud and if you can get back the compensation that you have already awarded them.

In order to do this, take a quick look at our questionnaire. Answering these questions can give you some insight on whether or not you are the victim of a false claim.

 

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