Examples of Fraudulent Workers' Comp Claims in California
March 20, 2020

Workers' comp fraud already costs the state of California up to $3 billion a year, and the problem is only getting worse. So, is there anything you can do to reduce workers' comp claims in California? Absolutely – below, we go over what workers' comp fraud is, how to spot it, and how we can help you stop the Claimitis problem that's plaguing California. 

Workers' comp fraud California: what it is  

Workers' comp fraud is when an employee lies, exaggerates, or otherwise misrepresents an illness or injury to benefit financially. It's estimated that up to 20 percent of employee comp claims are fraudulent, which is a trend we need to stop in its tracks.

Examples of fraudulent workers' comp claims in California

Fraudulent compensation claims aren't always easy to spot, but here's an overview of the most commonly used scams you'll come across.

Exaggerated injury or illness

Sometimes, an employee is injured or unwell, but they exaggerate their symptoms to claim more insurance money. For example, they've pulled a muscle in their leg, but they pretend they can't walk on it at all.

Feigning a workplace injury or illness

A worker might get injured off duty, but they claim that it's a workplace injury. For example, they might fall on a night out and hurt their back, but they claim they slipped on a wet floor at work. 

Pretend illness or injury

Sometimes, an employee might simply fake an injury or illness to claim the insurance money. 

Double dipping 

Double dipping is when an employee is medically unfit for work, and signed off by a clinician, but returns anyway. The employee then claims their paycheck and temporary disability benefits, which is obviously unfair – not to mention fraudulent. 

Reducing workers' comp fraud

The good news is that it's absolutely possible to stop workers' comp fraud in its tracks. Here's how to weed out legitimate comp claims from the rest. 

Test the evidence

Don't just take an employee's word for what happened – look for evidence. Are there witnesses, or is there security camera evidence? The less evidence available, the easier it is for you to defend the claim.

Look for inconsistencies

If an employee's story changes frequently, or if it becomes more elaborate as time goes on, this could be a sign that it's a false claim. Get in touch with us as soon as possible so we can investigate matters. 

Get proper medical assessments

It's vital that you have comprehensive medical evidence to evaluate a compensation claim. We'll connect you and your employees with our trusted network of healthcare professionals who can provide an accurate, reliable diagnosis. 

Set up return-to-work programs

A successful return-to-work program does two things: It saves you money, and it gets employees back to work as soon as possible. Our return-to-work program lets you check in with injured employees and keep an eye out for any injury exaggerations. 

About Samuel Hale

At Samuel Hale, we support employers in their fight against California's Claimitis problem. We're here to help you reduce the amount you're currently paying out on workers' compensation claims, and we'll work with you to mitigate future costs.  

We believe that it's time to fight back against California's broken, unfair compensation system. Don't struggle alone. Contact the experts at Samuel Hale today and see how we can help you tackle workers' comp claims fraud.

Fraudulent workers' comp claims in California cost taxpayers up to $3 billion a year.