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The Myth of Extensive Worker's Compensation Fraud by Claimants

September 18, 2016

Georgia Worker's Compensation Lawyers Examine The Myth of Extensive Worker's Compensation Fraud by Claimants

The insurance industry, employers, and others with a vested interest in discouraging workers' compensation claims and reducing the amount of payouts have perpetrated the widespread myth that the system is inundated with fraudulent claims. This myth is based on isolated anecdotal incidents with little effort to identify the actual scope of the issue. Although there are isolated cases of employees faking or exaggerating injuries, as well as other examples of illegitimate claims, experts generally recognize that the amount of fraud by claimants is infinitesimal. The rate of workers' compensation fraud involving employees is considered to be about one percent or less. Ironically, workers' compensation fraud committed by employers is far more extensive but almost never discussed in the media. In this blog article, our Atlanta workers' compensation lawyers generally discuss the existence of employer fraud and provide common examples.

Financial Incentives for Employers to Cheat Far Exceed Motivations for Employees to Engage in Worker's Compensation Fraud

Many people are unaware of the existence of employer workers' compensation fraud because it is so rarely discussed in the media or promoted as a problem. However, there are several reasons that indicate that it is far more prevalent than employee fraud. The first factor is the difference in incentives for employers and employees to cheat the system. The motivation to engage in fraud to receive $540 per week in benefit payments is almost non-existent compared to the millions of dollars that employers save by excluding entire classes of employees from obtaining workers' compensation benefits.

This disparity in the gains to be obtained by cheating also affects the risk-reward analysis for the parties on both sides of the employment relationship. When considering cheating, either party must consider the risk of detection and potential penalties compared to the reward associated with success in pursuit of the fraudulent scheme. The massive returns that employers can obtain from screening out hundreds of thousands of employees from worker's compensation benefits dwarf the rewards of an individual employee successfully obtaining benefits.

Common Forms of Employer Worker's Compensation Fraud Schemes

Some of the most common examples of employer/insurance carrier fraud include the following:

Misclassification of Employees: Employers frequently classify employees as 1099 independent contractors to avoid liability for worker's compensation benefits. Since workers classified as independent contractors do not qualify for benefits, employers often use bogus independent contractor agreements that disregard the high degree of control the employer wields over the daily tasks of the worker. When companies with hundreds, thousands, or even tens of thousands of employees engage in this type of practice, the financial gains for the employer are staggering.

Refusing Medical Care: Workers' compensation claimants are entitled to free health coverage for virtually all expenses, including diagnostic testing, doctor's appointments, specialists, medications, and other costs. However, carriers sometimes refuse to pay for necessary drugs and medical procedures.

Referring Employees to Biased Physicians: Employers often steer injured workers to unscrupulous doctors or industrial, medical clinics where the physician denies care, prematurely returns the employee to the job, or issues unjustified low permanent impairment ratings.

Retaliation: Some companies terminate an employee who files a workers' compensation claim to discourage other workers injured on the job from filing valid claims.

Improper Use of Health Insurance: Employees might be directed to use their health insurance for expenses that should be covered by the workers' compensation system.

Failure to Secure Coverage: Certain companies intentionally avoid purchasing workers' compensation coverage for their workers. This strategy shifts a significant portion of the cost of medical expenses from the employer's workers' compensation carrier to Medicare.

These are just a handful of the ways employers can engage in fraud schemes that result in a large number of employees receiving less in workers' compensation benefits or none at all. Our Atlanta worker's compensation lawyers have successfully represented many injured employees and protected clients from these types of sharp practices. We also often investigate a personal injury claim against third-parties who contribute to or cause our clients' injuries. This dual recovery approach can result in our clients receiving more compensation than if they settled for only workers' compensation benefits.

Put Our Law Firm's Over 38 Years of Experience to Work For Your Workers' Compensation Claim

If you or your loved one is injured on-the-job, our experienced Georgia worker's compensation lawyers diligently pursue workers' compensation benefits on behalf of injured employees as well as personal injury claims against third-parties depending on the circumstances. Montlick and Associates, Attorneys at Law, has been representing those who suffer serious injuries throughout Georgia and in the Southeast for over 38 years, including but not limited to Albany, Athens, Atlanta, Augusta, Columbus, Gainesville, Macon, Marietta, Rome, Roswell, Savannah, Smyrna, Valdosta, Warner Robins and all smaller cities and rural areas in the state.

No matter where you are located, the attorneys of Montlick and Associates, Attorneys at Law, are just a phone call away, and we will even come to you. Call us 24 hours a day/7 days a week for your Free Consultation at 1-800-LAW-NEED (1-800-529-6333). You can also visit us online at and use our Free Case Evaluation Form or 24-hour Live Online Chat.


Montlick & Associates, Attorneys at Law
17 Executive Park Dr NE
Atlanta, GA 30329
Telephone: 1 (404) 529-6333
Toll Free:   1 (800) LAW-NEED
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Office Location: 33.82937 -84.33779 

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Please Note:
Many of our blog articles discuss the law. All information provided about the law is very general in nature and should not be relied upon as legal advice. Every situation is different, and should be analyzed by a lawyer who can provide individualized advice based on the facts involved in your unique situation, and a consideration of all of the nuances of the statutes and case law that apply at the time.