Exposing Fraudulent Employee Injury Claims

Most employers’ work with their Workers Comp MGA in order to gain a better understanding of their workers’ compensation insurance. They understand how vital it is to comprehend all of the benefits it provides. But despite the fact that they carry coverage to aid employees who are injured while at work, one of the biggest concerns they have with the system is the number of fraudulent claims that are filed.


When an employee is injured on the job, the insurance provides funds to pay for any medical bills, plus a portion of any lost wages while the employee recovers from their injuries. There are laws protecting an employee fearing they may lose his or her job as a consequence for reporting an injury. However, there are some who will take full advantage and make a false claim in an attempt of trying to cheat the system.


Common workers’ comp fraudulent claims


Employers must ensure the system is being properly implemented and investigate any suspicious claims. Fraudulent activity can occur at every stage of a workers’ compensation claim. While working to reduce or eliminate fraudulent claims they must also uphold benefits for any legitimate claims that are filed.


Fraud occurs during the workers’ compensation process when the severity of an injury is being exaggerated. For example, even when an injury does occur, the injured party may pretend that the injury is much worse than it seems. In some cases, the worker may claim they haven’t had time to heal properly, even when they are healthy enough to return to work.


In extreme cases, an employee may actually allow themselves to get injured on purpose, or lay claim to injuries that have been completely falsified. Employees often file for workers’ comp for injuries that occurred in the past, or may already have an existing injury that they claim now as being recent.


Your client should be suspicious if there are no witnesses to the injury, or are faced with injuries with medical details that don’t match up to the employee’s version of what happened.



A good Workers Comp MGA program should help employers remain properly insured in order to aid them when legitimate claims are filed, all the while working to prevent false claims from being paid out.