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Workers' Comp Fraud Challenges

Fraud has been a growing concern in the workers' comp arena.

By Kathleen M. Bonczyk | Updated on March 05, 2007

Pursuant to the Workers’ Compensation Act, an injured employee’s exclusive remedies against the employer are generally limited to such benefits as temporary total disability payments and reasonable and necessary medical expenses. The underlying legal theory is that while claimants forgo an extensive range of tort damages available to them in other personal injury actions, they receive speedy and certain medical and lost-time payments and are not required to prove fault.

Fraud, however, has been a growing concern in the workers’ comp arena. Employees who elect to abuse the system do so at the risk of hefty criminal and civil penalties. Nonetheless, claim managers and adjusters who suspect fraud also should be cognizant of the relationship between fraud, slander, and libel actions, and the anti-retaliation and whistle-blower laws that operate to protect the rights of injured workers.

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