How To Detect Fraud

The National Insurance Crime Bureau has estimated the cost of Workers’ Compensation fraud to amount to $30 billion dollars a year in the United States.* Atlas works with Argus West to investigate fraud and reports findings to the District Attorney. Perpetrators of fraud can face serious consequences including fines and jail time.

You are our first line of defense in fighting fraud, which increases the cost of insurance for everyone.

If you suspect that a claim is not on the level, you should discuss your concerns with the claims representative.

Take a look at the following common red flags:

• Was the claim filed after termination?
• Has the employee complained of this injury in the past?
• Did the injury occur when no one was around to witness the accident?
• Do witness’ statements contradict the statement provided by the injured worker?
• Has a similar claim been filed by another employee in recent months?

If you answer yes to any of the questions above, you have identified a red flag that may suggest fraud. If you have any concerns regarding the validity of a claim, contact your claims examiner.

California Resources

For further information on Fraud and Fraud Prevention, please visit this link.

Check out this flyer you can post at your workplace. (click below to download and print)

*“Workers’ Compensation Fraud Convictions.” California Department of Insurance, California Department of Insurance, www.insurance.ca.gov/0300-fraud/0100-fraud-division-overview/25-wc-conv.