Workers’ Compensation Fraud – It’s Real and It’s A Problem

Workers’ compensation fraud exists in Texas. It drives up the cost of goods and premiums for all Texans. It is a continuing problem that needs to be addressed.

The Coalition Against Insurance Fraud estimates that more than $80 billion in fraudulent insurance claims are made annually (this includes all insurance lines including workers’ compensation fraud).  Tens of billions of dollars in false claims and unpaid premiums are stolen every year.

Workers’ compensation fraud occurs when someone willfully makes a false statement or conceals information in order to receive workers’ compensation benefits or prevents someone from receiving benefits to which they might be entitled. Workers’ compensation fraud is usually motivated by greed.

Examples of Workers’ Compensation Fraud

  • An employee fakes an injury in order to collect benefits;
  • An employee who is drawing benefits because he/she is supposed to be unable to work and is working full time at an unreported job;
  • A health care provider bills for services not provided; or
  • An employer misrepresents the amount of payroll or classification of employees in order to obtain a lower premium.

A list of workers’ compensation fraud indicators is available here.

The Division of Workers’ Compensation (DWC) has workers’ compensation fraud related information on their website.

DWC Ramping Up Anti-Fraud and Fraud Prosecution Efforts

The DWC established a dedicated Fraud Unit in 2016. The responsibility for investigating workers’ compensation fraud was transferred from the Texas Department of Insurance to DWC. The transfer allows experienced DWC staff to better monitor and investigate fraud specific to the workers' compensation system.

Since establishing the Fraud Unit, the DWC has received more than 2,500 reports of workers’ compensation fraud and investigated 96 alleged instances of fraud. In one case, a Houston health clinic owner entered a guilty plea and was sentenced to seven years deferred adjudication and ordered to pay $88,000 in restitution.

How to report suspected Workers’ Compensation Fraud

Workers’ compensation Fraud impacts all Texans. If you see workers’ compensation fraud or suspect workers’ compensation fraud, report it!

Report workers’ compensation fraud here and help fight fraud in the Texas workers’ compensation system.

Events

Aug 25-29

ICT Hurricane Media Tour

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Sept 18

Weathering the Storm - ICT Online Webinar
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Sept 19

ICT Workers' Comp Conference
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