Workers Compensation Fraud

For more information either refer to the website: http://www.lni.wa.gov/ClaimsIns/FraudComp/default.asp or contact your local L&I field office.

There are three types of fraud or abuse the Department looks for:

Injured worker fraud or abuse.

The worker was:

  • Not injured at all
  • Injured somewhere besides work but claiming it was on the job,
  • Doing "inappropriate activities" (one frequent example: playing sports while supposedly too badly injured to work)
  • Working a job while drawing time-loss for disability

 Health care provider-fraud or abuse. A doctor may be:

  • Billing for services that weren't performed
  • Billing for more expensive services than were delivered
  • The one doctor people go to when they want a certain kind of diagnosis to be able to draw workers compensation.

Employer fraud or abuse. An employer may be:

  • Not reporting any or all employees to L&I and therefore getting a "free ride" on insurance at the expense of other employers.
  • Reporting fewer hours than the employees have actually worked.

If you suspect someone is committing fraud and want to make a report to L&I, you may call 1-888-811-5974.

A list of some "red flags"

Claim Fraud: Not injured at work (or not injured at all)
If you see someone who … Then…
  • Appears to have been injured, but no one else witnessed the accident.
  • Gives conflicting stories as to how the injury occurred.
  • Appears to have let a lot of time elapse between the injury and the date they first got medical treatment.
  • Appears to have sustained the injury while off work.
  • Appears to have been injured immediately prior to a planned strike or the completion of a job.
  • Appears to have been injured immediately prior to or after a disciplinary action against them.
  • Appears to have been Injured immediately prior to being terminated from their job.
  • Moves out of the state or the country shortly after the alleged injury.
  • Appears to have a history of filing multiple claims.


Report Claim Fraud

or
Call: 1-888-811-5974

Unfair Benefits Fraud: Doing activities inappropriate for an injured worker
If you see someone who appears to … Then…
  • Participate in recreational or other activities inconsistent with alleged injury.
  • Claim dependents not in his legal/personal custody.
  • Claim a spouse when not married.
  • Misuse drugs or display drug-seeking behavior (prescription or non-prescription).
  • Frequently change doctors ("doctor shopping").


Report Unfair Benefits Fraud
or
Call: 1-888-811-5974

Disability Fraud: Working while on disability
If you see someone who appears to … Then…
  • Be working while on time-loss.
  • Be regularly away from home during normal business hours.
  • Be receiving unemployment benefits while on time-loss.
  • Be working and being paid "under the table" while receiving time-loss benefits.
  • Be doing "volunteer" work while receiving time-loss benefits.

Report Disability Fraud
or
Call: 1-888-811-5974

Potential Fraudulent Activity by a Health Care Provider
IF you know a provider who… Then…
  • Bills for treatment on consecutive dates of service for minor allowed conditions.
  • Conducts business with the same doctor(s) and attorney(s) that repeatedly have the same questionable claims.
  • Bills for services that did not occur.
  • Bills for different services than were received.

Report Health Care Provider Fraud
or
Call: 1-888-811-5974

Potential Fraudulent Activity by an Employer  
IF you know an employer who… Then…
  • Is operating a business without the proper license or registration and has workers.
  • Pays workers in cash and doesn't give them any kind of payroll stub.
  • Gives workers a 1099 form instead of the standard W-2.
  • Submits bids on jobs well below the industry standard.
  • Pays workers other than in cash or check, by such things as free rent, reimbursement of expenses, barter, etc.
  • Has a large number of corporate officers listed for the firm, and all work at the firm.
  • Does not maintain or report complete and accurate employee payroll information.
  • Pays workers on a piece work basis and does not record hours.
  • Requires employees to work long hours but turns in fewer hours than they actually worked.
  • Has a worker who gets injured on the job, and the employer promises to pay the doctor and medical bills rather than report the accident to L&I.
  • Reports hours on and injured worker's accident report that do not match the hours the employer reported to L&I.
  • Has workers who find they do not qualify for unemployment insurance because the employer under-reported their hours.
  • Hires their own kids to work for the firm (other than on a family farm).
  • Has several "corporate officers" who do not exercise control of the business operations.

Report Employer Premium Fraud
or

Call: 1-888-811-5974

 

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