Many think that workers’ compensation fraud is running rampant, and it may be in some areas. We see the worst cases in presentations or in media reports. However, the media and conference speakers do not talk about the many parties involved in workers’ compensation who act honestly and ethically within the entire process, and who do all they can to reduce the negative impact on the injured employees. We also do not focus as much as we should on our own processes or execution failures that contribute to certain categories of what some call fraud or malingering.

Let's look at three types of workers’ compensation claimants who may commit various degrees of “fraud,” some of which may be due to poor management or the process-oriented nature of workers’ compensation claims management in the current environment. They are:

1. Abusers.
2. Opportunists, and
3. Forgotten, frustrated, and forlorn employees.

The Abusers

These employees were not injured at work, but were injured elsewhere or previously and claim the injury occurred at work. Some of these will not only file multiple fraudulent workers’ compensation claims, but will also file fraudulent automobile or general liability claims.