Is it true most workers’ compensation claims are faked so people can get free benefits?

worker_in_painThere will always be stories of workers committing workers’ compensation fraud. Some involve workers faking an injury to get a free vacation; others allege employees exaggerate the costs of their medical care. There are also claims of employees working together with crooked medical providers to steal money from employers.

While fraudulent claims do occur from time to time, the truth is they're extremely rare, occurring in less than two percent of workers' compensation claims nationwide.

The Myth of Workers’ Compensation Fraud

Although this kind of fraud rarely occurs, it places blame and suspicion on employees who have little to gain by cheating the system. Employees often have to provide receipts for their medical bills and adhere to strict disability laws, and the small amounts they're given aren't enough to make them wealthy. However, as long as this myth of fraud persists, employers remain mistrustful of workers injured on the job, and insurers can continue to gather information to prove an employee is lying about his condition.

In most cases, employees won't even become wealthy if they file a worker’s compensation lawsuit, since the amount a worker could get for his or her lawsuit depends on:

  • Eligibility. Workers' compensation operates under a doctrine of “exclusive remedy.” This means a worker loses the right to sue if he or she accepts workers' compensation payments. Most workers cannot sue unless the accident occurred because an employer was extremely negligent or has broken the law.
  • Fault. In a lawsuit, the employee’s own liability for the accident can also be considered, potentially reducing the settlement. However, for standard workers' compensation benefits, injured workers can collect even if they were at fault for the accident.
  • Total awards. Even if an employee is successful in a workers’ compensation suit, he or she is expected to return all of the money received through workers' compensation prior to the court settlement, and will be ineligible for any future payments for the injury through the workers' comp system.

The amount a worker receives is calculated carefully to provide compensation for concrete losses, such as past medical bills and loss of income. Victims can be awarded sums in the millions or tens of thousands of dollars, but will likely have to live off that money for the rest of their lives—especially if they're permanently disabled. In many cases, these settlements are the employee’s only hope of living a normal life. If you need help after a work injury, call us today or fill out the form on this page to set up a consultation with an attorney.

 

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