Many think that workers’ compensation fraud is running rampant,and it may be in some areas. We see the worst cases inpresentations or in media reports. However, the media andconference speakers do not talk about the many parties involved inworkers’ compensation who act honestly and ethically within theentire process, and who do all they can to reduce the negativeimpact on the injured employees. We also do not focus as much as weshould on our own processes or execution failures that contributeto certain categories of what some call fraud or malingering.

Let's look at three types of workers’ compensation claimants whomay commit various degrees of “fraud,” some of which may be due topoor management or the process-oriented nature of workers’compensation claims management in the current environment. Theyare:

1. Abusers.
2. Opportunists, and
3. Forgotten, frustrated, and forlorn employees.

The Abusers

These employees were not injured at work, but were injuredelsewhere or previously and claim the injury occurred at work. Someof these will not only file multiple fraudulent workers’compensation claims, but will also file fraudulent automobile orgeneral liability claims.