Did they really think they could pull off these costly comp scams?

You know how much it costs for an employee to go out on workers’ compensation, both in direct and indirect costs. But what if that person is milking it for all it’s worth? Or even faking it?

It happens … a lot.

Workers comp fraud is estimated to cost $7.2 billion a year.

And a few recent cases in the news may have you wondering whether employees think their employers are downright dumb:

1. A U.S. Postal Service employee was recently convicted for workers’ comp fraud. She had been collecting workers’ comp since 2004 because an injury left her unable to sit, stand, kneel, squat, climb, bend, reach or grasp.  Yet in 2008 she was seen on TV hoisting both hands over her head to spin the big wheel during the Showcase Showdown in The Price is Right! Twice!
2. An Oxnard, CA police officer was just sentenced to 120 days in jail for his workers comp scam. He told his supervisors he had hurt his back and needed to be assigned to light duty – yet was playing on an adult baseball league while out on disability. He no longer has his job and was fined $120,000.
3. Another postal worker who was out on workers’ comp and then put on light duty due to a back injury was discovered to be running 80 long distance races (and winning some of them), including the Boston Marathon. She was sentenced to three years probation last summer.

Yes, these are some extreme examples and likely belong in the criminal Hall of Shame for their blatant abuse of the benefits.

But there are much more subtle ways less-than-honest employees may try to take advantage of the system, while your company pays the bill.

Spotting the signs

No one’s going to be tailing injured staffers after hours and playing amateur private detective (that’s the last thing you want!).

But any of these situations may throw up a red flag for you and could be worth some follow-up:

• No witnesses. Tougher to refute what an employee’s saying happened when no one else was there to see it happen!
• Conflicting accounts of what happened. Yes, this may be between co-workers, but it could also be a contradiction between what the employee says happened and what a doctor says about the injuries sustained.
• Incident follows an event that makes an employee dissatisfied. Was this person just passed over for a promotion? Didn’t get the raise she was expecting? Often, this type of abuse occurs after someone feels wronged by his/her employer.
• Suspicious timing. Fact: Most questionable claims are filed on either a Friday or a Monday. Also, be wary of an injury that occurs during rumors of layoffs or a strike.
• Inconsistent injury. Something may be off if the type of injury isn’t consistent with what the person was doing when he or she sustained it.
• Reporting lag. An employee should speak up about an injury right after is happens. When there’s a long gap between the incident and reporting, something may be off.
• Lack of contact. Tough to reach that injured individual? If that employee is tough to locate or isn’t cooperating with requests for medical treatment, they may be trying to hide something …. at your company’s expense.

Info: Common signs of WC fraud adapted from “Tips on Spotting Workers’ Comp Fraud”