Employee Fraud Least Costly Workers’ Comp Fraud

By Denise Johnson | September 12, 2013

  • September 12, 2013 at 3:24 pm
    David says:
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    Too bad there is no information about preventing the more costly employer and medical provider fraud.

  • September 12, 2013 at 10:14 pm
    V.O.C.A.L. says:
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    I would have answered your poll but the most serious and costly fraud is left out of the available answers. That would be number 4.
    “Insurance fraud called “lowballing” committed by the Workers Compensation Insurer to avoid paying legitimate medical and financial claims.” That one ladies and gentlemen is my choice. as it would be the choice of hundreds of thousands of North Americans who have been forced onto food stamps, welfare, have lost their possessions and savings, have committed suicide or died of a heart attack, stroke, or ulcers brought on by psychologically abusive appeals processes, combined with severe Chronic Pain, and the indignities of having been forced by your criminal activity into a state of absolute poverty. It is a pattern you exhibit in denying the most serious injury claims, claims in which you already know the claimant is totally disabled from employment. Ask the tens of thousands of injured workers in each State and Province in North America. The evidence is overwhelming and you are denying claims at an ever increasing rate leading directly to the increased taxation, social programs such as food banks, a drain on available public resources, no recovery for the patients, and in general dumping your most costly claims onto society at large. All the while you enjoy exorbitant salaries, have billions in the bank, collect bonuses as a percentage of denied claims, and by doing so have caused the death of thousands of injured workers in North America. As they said in the old days. “The jig is up Gentlemen.” In other words, you are caught red handed denying claims that lead to the patient’s death. Only a matter of time before you are all behind bars. Have a good day.

    • September 19, 2013 at 8:08 pm
      Former Adjuster says:
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      There are bonuses for denying claims? I obviously worked at the wrong carriers and TPA’s. Can you support any of those allegations with statistics (facts)? I did not think so.

  • October 10, 2013 at 9:36 am
    M. Prankster says:
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    I fell down the stairs at work a few years back and several employees came to my aid. I was in a lot of pain the next day, notified my employer by email and went to the hospital for x-rays. I returned to work that day. When the employer got the bill from the hospital several months later, it notified its WC carrier to deny the claim, said the accident did not occur there, knew nothing about it, etc. etc. Claim was just for payment to the hospital ER. I had to file a petition for a court hearing and notified the carrier I had witnesses to the fall. Boy did that adjuster call me in a hurry. He treated me like some kind of get-over artist over the phone. Then he was amazed that all I wanted was for the company to pay my ER visit bill! The carrier had to put its attorneys on notice when I filed for a hearing and their attorneys also sent me denial letters. So if the employer had just owned up to the accident and reported it in the first place, the comp carrier would have paid less.

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