It seems that every day we hear about layoffs in the local or regional workforce. Recent Peoria County unemployment rates have passed nine percent. With workers’ compensation fraud varying from five to 25 percent of cases nationally, there is a growing concern among employers that some employees may claim injuries, believing they will avoid being a casualty of company layoffs. Although these employees would be mistaken, employers can see a rise in workers’ compensation costs during these periods of economic downturn.
Employee-generated workers’ compensation fraud is generally committed in two ways. First is the obvious—faking an injury. Not so long ago, I worked as a therapist performing functional capacity evaluations (FCE). On one occasion, an “injured” worker scheduled for an FCE used the bus line to come to the clinic. On the first day of testing, this worker was observed getting off at the nearest bus stop and running a city block to the clinic.
Once in the clinic, this worker developed a drastic limp that persisted throughout the day’s testing. After testing was completed, the worker limped to the front door, and then ran again to the bus stop. This performance was repeated the following day as well. While most people who report injuries are indeed injured, this is an example of the small percentage of people who do fake injuries.
The second type of fraud committed by the employee is what many term malingering (this is a legal term, not a medical one). Malingering involves an actual injury, with the injured worker misreporting or exaggerating symptoms, pain or functional limitations in hopes of getting more time off work, money in settlement, sympathy from others and/or any number of other reasons.
It is important to make a distinction between malingering and individual responses to injury, as people do recover differently from similar injuries. One worker may take two weeks to fully recover from a back injury (working modified duty in the interim, of course), while another could take a couple of months to fully recover. Many intrinsic and extrinsic variables go into the healing/recovery process. Malingering versus individual recovery rates is an issue that a well-seasoned occupational health practitioner should be able to differentiate.
There are some steps an employer can take to uncover these types of fraudulent behaviors. The most important factor is to investigate all alleged injuries thoroughly and quickly. Obtain a detailed written statement from the worker as soon as possible. Interview not only the injured worker, but also any witnesses to the injury. Check logbooks and documentation to see if the worker was feasibly doing what was claimed. Sequester and examine potentially faulty equipment, if stated as a cause. Have the worker evaluated by the provider of your choice as soon as possible. (Yes, you can do this legally.) Immediate, thorough investigation can save an employer the time, hassle and money involved in claims, legitimate and fraudulent. iBi
