L&I News

See more More news releases

Nov. 8, 2005

L&I using new software to detect workers’ comp fraud

TUMWATER — The Department of Labor & Industries (L&I) has begun running every open workplace-injury claim through software that will help detect workers’ compensation fraud.

The software screens claims based on about 100 criteria, looking for irregularities such as delays between doctor’s appointments and care that is inconsistent with the injury. Claims scoring high will be assigned to the most experienced claim managers for review. Questionable claims will be turned over to L&I fraud investigators.

“Detecting fraud early and preventing it is one of our top priorities,” said L&I Director Gary Weeks. “This software gives us a cost-effective way of targeting our anti-fraud effort so that we identify and close a fraudulent claim before we’ve paid out thousands of dollars in benefits.”

L&I has contracted with Fair Isaac Corp., which will use its software to scan every open time-loss claim twice monthly. A one-time charge of $16.26 will be billed to the claim. No matter how many times the software scans the claim, the claim will only be billed once.

L&I’s Fraud Prevention and Compliance Program targets workers who file false claims and collect benefits they aren’t entitled to, employers who don’t pay their premiums and providers who charge for services they didn’t perform. In fiscal year 2005, 19 L&I fraud investigations were turned over to county and federal prosecutors.

L&I runs the state’s workers’ compensation system, which provides insurance coverage to about 2.3 million workers and 161,000 employers.

Radio broadcast version (:30)

The Department of Labor & Industries says it has begun using new software that will help it detect workers’ compensation fraud. The software screens every open workplace-injury claim based on about 100 criteria, looking for irregularities such as delays between doctor’s appointments and care that is inconsistent with the injury.

L&I says claims scoring high will be assigned to the most experienced claim managers for review, and questionable claims will be turned over to L&I fraud investigators. L&I Director Gary Weeks says the software gives the agency a cost-effective way of targeting its anti-fraud effort so that fraudulent claims can be identified and closed before thousands of dollars in benefits have been paid out.

# # #

For media information: Robert T. Nelson, L&I Public Affairs, 360-902-6043 or nelq235@LNI.wa.gov, or visit the L&I News and Media Center at www.lni.wa.gov/News.

Fax transmittal number: 360-902-5420

On the web at Fraud.LNI.wa.gov.

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.