Workers’ compensation insurance fraud can be committed by employees, employers, insurers, agents, doctors, lawyers or anyone else involved in the workers’ compensation process. But workers’ comp fraud primarily penalizes employers and their employees.
When someone fakes or exaggerates a job-related injury or illness to collect benefits, it often causes insurance rates to go up, which can leave employers with less money to provide employees with raises, paid vacations and other benefits.
While the majority of workers’ comp claims are filed in good faith, experts agree that a number of them are fraudulent and that employers should be on the lookout for the following warning signs.
Red flags include claimants who:
- Do not complain when their checks are late, or fail to show up to collect their checks.
- Present conflicting medical information.
- Change the frequency of communication with claims adjusters.
- Claim injuries that are not easily detected, such as back and neck injuries or carpal tunnel syndrome and other conditions related to repetitive motion trauma.
- Have prior workers’ compensation claims history.
- Present claims for non-labor intensive injuries.
- Present pain-related injuries but refuse to undergo surgery or physical therapy.
- Present claims related to mental health.
- Are uncooperative and argumentative.
- Present diagnosis changes after or during claims periods.
- Fail to keep scheduled medical examinations.
- Are experiencing financial difficulties.
- Have records of excessive absenteeism prior to filing workers’ compensation claims.
- Move out of state following an accident or use a post office box for a home address.
- Have worked in the same position for a lengthy period of time and have become bored with the job.
- Are never home when called, but return calls later in the day.
Employers should exercise extreme caution before confronting an employee they suspect of fraud. Uncovering a fraudulent claim can result in substantial savings, but a competent investigator and legal counsel should be consulted before any action is taken against an employee. Doing so will help you steer clear of false accusations that could lead to costly litigation.
Your Home Builders Association of Greenville has formed a new company, Home Builders Contractor Risk Solutions, to offer workers’ compensation insurance.
Home Builders Contractors Risk Solutions was established to provide members of the Home Builders Association of Greenville and non-member contractors with a stable and competitive option for workers’ compensation insurance. Commercial and residential contractors, subcontractors, suppliers, and other businesses affiliated with the construction industry also will benefit from participating in the program.
- Founded, owned and operated by the HBA of Greenville
- Worker’s compensation insurance at competitive rates
- Coverage in all 50 states keeps your workers’ compensation insurance under one policy
- Available to non-builder contractors and associated businesses
- Proactive risk management to prevent injuries and claims, reducing your insurance costs
- Sold through professional, independent insurance agents
Administration of the new program will be handled by J. Freeman and Associates in Greenville, SC, with Patriot National Insurance Group as the insurance underwriter.
All HBA of Greenville members participating in the plan will receive a 5 percent discount on their premiums. Combine this discount with superior claims handling and group purchasing power and you have a program worth considering!
For a no-cost, no-obligation quote, please contact your insurance agent or call Christie Hannon at J. Freeman and Associates at 864-331-4400.
The HBA of South Carolina and the S.C. Workers Comp Commission are working on a web portal for home builders and general contractors to verify workers comp coverage of their subcontractors.
The goal of the site is for contractors to register to receive notifications of changes in coverage of their subcontractors. If a subcontractor’s coverage lapses, the contractor will receive an email notifying him or her of the change of status.
The new site is pending a memorandum of understanding between the HBA of South Carolina and the S.C. Workers Comp Commission. The purpose of the project is the protect contractors from becoming the employer of record when a subcontractor on their job site allows his or her worker’s comp insurance coverage to lapse.
This project will benefit the entire industry and is being undertaken by the Home Builders Association of South Carolina.
The South Carolina Home Builders Self Insurers Fund was named the National Association of Home Builders Associate Member Safety Program of the Year. The award will be presented on February 7 at the International Builders Show in Orlando, Florida.
Your Home Builders Association of Greenville endorses the SIF and recommends it to our members as a source for your Worker’s Compensation Insurance needs.
The Safety Award For Excellence (SAFE) recognizes NAHB member companies, workers, and other individuals for the excellent safety programs that make them leaders in the residential construction industry. The NAHB annually recognizes those who have worked to achieve exemplary safety and health in residential construction. There were more than 40 applicants for SAFE awards in 2011.
The SCHBSIF assists its members in providing safe work places by conducting safety training that is specific to the home building industry. It also provides on-site safety surveys for its more than eight hundred members. These surveys assist home builders and subcontractors in identifying hazards and provide them with recommendations for corrective actions that reduce the potential for injuries in the workplace.
South Carolina Home Builders Self Insurance Fund has announced the name of the insurance company that will succeed the fund when it converts to a mutual insurance company this summer: South Carolina Home Builders Insurance Group.
The SIF is planning to convert to a mutual insurance company on July 1, 2011, for all new policies. Existing policy holders will have their insurance written by the new company beginning in 2012.
The conversion to a mutual insurance company is intended to make the Home Builders Association’s workers compensation insurance program more competitive.