Sniffing Out Fraud in Workers’ Compensation July 12,2019

Do you suspect a fraudulent workers’ compensation claim at your organization? If so, that’s serious. Fraudulent claims cost businesses like yours millions of dollars every year. They waste resources that can help workers with real injuries.

Injured worker fraud
How do you spot a possibly fraudulent claim by an employee? What are the red flags?

  • A new employee files a claim.
  • An injured worker hires an attorney the day of the accident.
  • In repeated interviews, the employee changes his or her story.
  • There’s a long delay between the accident and the filing of the claim.
  • The claim coincides with the worker’s layoff or termination.

Fraudulent certificates of insurance
If your business hires independent contractors, make sure their certificates of insurance are valid. Obtain them directly from Pinnacol or one of its affiliated insurance agents. If a contractor with a fraudulent certificate becomes injured and needs care, your organization could be on the hook. Watch for these signs of a fraudulent certificate:
  • A print date that’s outside of policy effective and expiration dates.
  • Font inconsistency.
  • Misspellings and grammatical errors.
  • Faint or crooked lines.

Other kinds of fraud
Employees are not alone in committing workers’ compensation fraud. Offending employers knowingly underreport payroll, misrepresent the nature or volume of their businesses or alter certificates of insurance. Dishonest medical providers charge for visits, care or treatments that injured workers never receive or they falsify patient information.

Pinnacol resources
If you believe your organization has experienced a case of workers’ compensation fraud, contact Pinnacol’s Special Investigations Unit at 303-361-4000 or 800-873-7242. Our investigators will determine whether fraud has been committed. To learn more about fraud, visit There’s a poster you can download for your worksites, as well as more than 20 informative articles on the subject.

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