Workers’ Compensation Fraud Harms Everyone

What is workers’ compensation fraud?

Workers’ comp fraud occurs when someone cheats the system or doesn’t tell the truth when they are involved in a workers’ compensation matter.  When most people think of workers’ comp fraud, they think about a person lying about their injury so they can get workers’ compensation benefits; but, it isn’t limited to them.  Fraud can also be committed by employers, insurance agents, insurance adjusters, attorneys, medical provider—practically any individual involved in a claim.

Examples of Fraud

Fraud by Workers

  • Workers who claim a work-related injury that is not work related.
  • Workers who exaggerate the extent of their injury.
  • Workers who make a claim for an injury that did not happen.

Fraud by Employers

  • Employers that make employees pay for their own workers’ compensation insurance coverage by taking money out of their paycheck.
  • Employers that pressure employees to not file a claim, even when they are injured at work.
  • Employers that call their workers “independent contractors” rather than “employees” to avoid having to pay workers’ compensation premiums.
  • Employers that claim that their employees perform safer jobs than they actually perform, such as saying that its workers are secretaries when they are actually electricians, or painters, or...
  • Employers that don’t buy a workers’ compensation policy even though it is required by law, hoping that the Bureau won’t notice it or catch them.
  • Employers that understate its actual total payroll or pay its employees “under the table” in an effort to lower its workers’ compensation insurance premium costs.
  • Employers that withhold information from its insurance carrier so it can get lower workers’ compensation premiums.  This usually happens when employers suggest/require injured workers to file their claim under their group insurance plan or when employers pay for the benefits themselves without notifying its insurance carrier.

Fraud by others:

  • Insurance adjusters who provide benefits to injured workers that the worker is not supposed to receive.
  • Attorneys who plot with physicians to obtain medical opinions that would be beneficial to their clients even though the opinions are not based on facts.
  • Nurse Case Managers who do not maintain their independence.
  • Medical providers who send bills to the insurance company for services they did not provide.
  • Insurance agents who sell bogus workers’ compensation insurance policies to unwitting employers, accepting payments for the premiums but never notifying an insurance carrier.  In other words, no policy is ever actually written.  (This was the case in Sullivan County, Tennessee recently.  Two women were indicted on money laundering, insurance fraud and theft after being charged with conspiring to create fake workers’ compensation policies and pocketing premium payments.)

The Bureau is committed to stopping workers’ comp fraud!

  1. The Bureau has a statewide Compliance Program that investigates employers to make sure that they have any required workers’ compensation insurance coverage. These investigators also look into how the employer has classified its workers.  This program assesses and collects penalties, as appropriate.
  2. The Bureau’s Penalty Program investigates reports of insurance adjusters, medical providers and others that don’t comply with the requirements of the workers’ compensation law and rules.  This program also assesses and collects penalties, as appropriate.
  3. We also have an Ombudsman Program that will answer questions about Tennessee’s workers’ compensation system.  You can reach an ombudsman by calling 800-332-2667 or by emailing them at wc.info@tn.gov.
  4. The Bureau has other ways to help improve public awareness:
    • Request a Speaker from the Bureau to deliver a training session to your group on Fraud Awareness or detection by emailing us at wc.info@tn.gov or by calling 800-332-2667.
    • Report employees, employers, insurers or others that you suspect are committing fraud directly to your District Attorney.  Your district attorney may be located within the district directory.
    • Employers should hang the Bureau’s “Workers’ Comp Posting Notice” in their worksites.  This notice notifies provides important information to employees about how to report a workplace injury.
    • You can report employers that you suspect are not providing workers’ comp insurance benefits by completing a Request for Investigation Form.  This form will allow you to submit, anonymously if you prefer, the names of any employers that you think are thought to not complying with the coverage requirements of the Workers’ Compensation Act.
    • You can report employers that you suspect are calling their workers “independent contractors” when they are actually “employees” by completing an Employee Misclassification Tip Form.  This form allows you to submit, anonymously if you prefer, the names of any employers that you think are not properly classifying their workers.
  5. The Bureau helps improve awareness with its staff by:
    • Training its investigators on the ways people commit fraud and the tools that they can use to uncover them.
    • Training its attorneys in the Compliance, Penalty and Ombudsman programs on the proper ways to make referrals to the appropriate Attorney General.

What you can do to help eliminate fraud

  • If you are a business owner operating in Tennessee, carry workers’ compensation insurance if the law requires you to do so. 
  • If you are injured at work, know your rights and responsibilities.  Employees have rights to certain benefits as outlined in the Tennessee Workers’ Compensation Act if work is the primary cause of their injury.  But, certain responsibilities come with those rights. 
  • If you are an employer, know your rights and responsibilities in case one of your employees reports an injury.  Employers have rights to place some limitations on an injured workers’ medical treatment.  But, employers also have certain responsibilities to provide a safe workplace. 
  • If you are a medical provider, case manager, insurance adjuster, attorney, or anyone else involved in a workers’ compensation claim, know your rights and responsibilities.  The Bureau’s website provides a wealth of information for everyone involved in a claim.

Please join the Bureau’s efforts to help eliminate workers’ comp fraud in Tennessee.