Injured Worker Fraud — Washington State

Claim fraud: Not injured at work (or not injured at all)

Below are a few of the behaviors that might indicate injured worker fraud.

Spotting the red flags

If you see someone who…

  • Is injured but there are no witnesses.
  • Gives conflicting stories of the injury.
  • Significant time lapse between the injury and the first medical treatment.
  • Injured while off work.
  • Injured immediately prior to a planned strike, or the completion of the job.
  • Injured immediately prior to or after a disciplinary action against them.
  • Injured immediately prior to being terminated from their job.
  • Moves out of the state or the country shortly after the injury.
  • Frequent injuries.
  • Suspicious Activity for an injured worker.

If you see someone who…

  • Participates in activities inconsistent with the injury.
  • Claims dependents not in his legal/personal custody.
  • Claims a spouse when not married.
  • Drug-seek (prescription or non-prescription).
  • Frequently changes doctors.
  • Work while receiving worker’s compensation.
  • Leave and return home during normal business hours.
  • Paid “under the table”, or cash.
  • Volunteer while on worker’s compensation.
  • Collect wages for providing home care while on worker’s compensation.

Report Unfair Benefits Fraud by calling: 1-888-811-5974 (option #3) or file a report online.

Workers compensation fraud

RCW 51.32.240 – Erroneous payments – Payments induced by willful misrepresentation – Adjustment for self-insurer’s failure to pay benefits – Recoupment of overpayments by self-insurer – Penalty-Appeal-Enforcement of orders.

Recipient shall repay any such payment together with a penalty of 50%. Such repayment or recoupment must be demanded or ordered within three years of the discovery of willful misrepresentation.

WAC 296-14-4125 – How does the department calculate the amount of overpayment charged to a claimant when a determination of willful misrepresentation has been made after initial claim adjudication?

The overpayment calculation includes all or part of wage replacement benefits and may include permanent partial disability benefits, vocational benefits, medical benefits, and/or other medical aid fund benefits paid on the claim.

WAC 296-14-4126 – How does the department calculate the amount of overpayment charged to a claimant when a determination of willful misrepresentation has been made after initial claim adjudication?

The overpayment calculation includes all or part of wage replacement benefits and may include permanent partial disability benefits, vocational benefits, medical benefits, and/or other medical aid fund benefits paid on a claim.

RCW 51.48.250 – Liability of Persons willfully obtaining erroneous payments – Civil Penalties.

Not to exceed the greater of $1,000.00 or three times the amount of such excess benefits or payments.

Adjustment in Penalties for Inflation

RCW 51.48.095– Adjustment for inflation.

Penalties payable pursuant to this chapter shall be adjusted for inflation every three years, beginning July 1, 2023, based upon changes in the consumer price index during that time period.

Impacts: RCW 51.48.080, RCW 51.48.250, RCW 51.48.270 and RCW 51.48.280.

Investigations Penalty Table
Investigations Penalty per changes in accordance with RCW 51.48.095 July 1, 2020 July 1, 2023
RCW 51.48.080​ $1,000.00​ TBD
RCW 51.48.250​ $1,000.00 ​ TBD
RCW 51.48.270​ $25,000.00​ TBD
RCW 51.48.280 $25,000.00 TBD