Workers Comp Insurance Fraud: Business Situations, Injuries, Medical Claims and the Unlawful

Unfortunately, the insurance industry has always reported incidents of fraud, whether it be in relation to homeowner insurance, business, auto, life, umbrella, or even bonds. No niche, however, is so vulnerable to fake claims as workers compensation. Read these eye-popping cases, and join the insurance companies’ fight against fraudulent activity.

Robbing from the Rich to Give to the Poor

This may seem straight from the fairy tale books, but it’s true!

An elderly physician was found guilty of workers compensation fraud. His criminal activity consisted of filing dishonest insurance claims totaling more than $170,000. The ‘good’ doctor pleaded with the sentencing judge for mercy as he explained the facts of his crime. What made him different than other thieves was that he had deliberately overcharged patients who had their medical bills paid for by workers comp coverage. In this way, he was able to service patients who could not afford to pay out of their own pockets. The judge took this in consideration when sentencing him to only 5 years of probation and a year of confinement in his own home.

A Sad Conclusion

A former employee hurt his arm while on the job and continued to collect disability benefits even after there was improvement and he massaged clients for a fee. The US Department of Labor got wind of the deception and accused him of one count of felony in connection to insurance fraud.


A policewoman suffered injury while she trained for her position. After she left the force, she continuously collected workers compensation checks while simultaneously receiving disability retirement benefits. Then, it was uncovered that during this time she joined twenty-nine running competitions and participated in an intense swim contest, finishing in record time.

Faker becomes Jail-Sitter

One guy so good at faking injuries collected 6 separate workers comp benefits for ‘related’ boo-boos at various ‘places of employment’. He didn’t only receive almost $500,000. He finally got his full-due when he was caught pretending to be someone hurt at a pretend business: twelve years of jail time for false injury claims.

Workers Compensation, Ambulatory Surgery Centers and Hospitals

Unfortunately, the facts don’t lie. This from the Workers Compensation Research Institute:

Operations done at ambulatory surgery hubs are frequently less costly than hospital out-patient places! This report assessed 2/3 of the maximum workers comp disbursements across the United States of America for typical operations performed at ambulatory surgery centers and hospital outpatient surgeries.

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