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About Fraud

Accident Fund Insurance Company of America works closely with insurance agents and employers to prevent, investigate, and in specific cases pursue conviction of those who commit workers compensation fraud. While actual fraud in the workers compensation industry involves less than 4% of claims, the expense to employers and the industry equals millions of dollars annually.

It's very important to note that the well being of your employees should be your first concern. Workers compensation insurance provides for comprehensive medical care and lost wages for workers who legitimately deserve this protection. Here's some basic awareness and prevention information regarding fraud in the workers compensation industry, so that you will be aware of the warning signs and understand how to report suspicious situations to Accident Fund Insurance Company of America for investigation.

What is fraud?
Fraud is deliberate deception to secure unlawful gain.

What are the types of workers compensation fraud?
The following scenarios are just a few examples of fraudulent activity that could take place in regard to workers compensation:

  • Employers falsely reporting payroll figures to reduce premiums
  • Employees making a workers compensation claim who sustained an injury someplace other than at work
  • Employees collecting workers compensation wage payments while working at another job
  • Physicians billing for services not rendered

Unusual circumstances, questionable events or a difference between your records and your memory do not necessarily mean fraud has been committed. Misunderstandings, lack of awareness or errors can often be cleared up easily. The professionals at Accident Fund Insurance Company of America will help you determine if there is cause to be concerned about fraud.

What is my role, as a supervisor, in fraud prevention and detection?
As a business owner, supervisor or manager, you have an important role in recognizing and preventing fraud. When hiring, your procedures may help protect your company from potential problems. When an injury is reported and fraud is suspected, your record of the situation may well provide the most important information for the investigation. Beyond that, you can rest assured that Accident Fund's investigation team and legal staff will pursue actual fraud cases with great determination. In fact, Accident Fund Insurance Company of America is well known for its success in prosecuting fraud.

What are some of the warning signs for potential fraud when an employee reports an injury?
Fraud can happen at any stage of the claim process. Potential warning signs might include:

  • Claims reported first thing in the morning (especially Mondays) or just after lunch
  • Claims in which the story details surrounding the injury change over time
  • A medical bill that reflects services not provided
  • An injured employee rumored to be working at another job
  • An injury sustained in a highly populated work area with no witnesses

How can I help stop fraud at my workplace?

  • Let employees know that workers compensation fraud will not be tolerated and will be prosecuted. This message will be welcomed by all honest employees.
  • Post Accident Fund Insurance Company of America fraud posters in your workplace.
  • Always report all claims immediately to our Express Claims line in Michigan:1-800-888-0616 all other states 1-866-206-5851.
  • When hiring, always do a work history check to verify references and employment history.
  • If you suspect fraudulent activity, or have information regarding a fraudulent claim, call toll-free 1-800-944-FRAUD to report the activity. All calls are confidential and can be made anonymously if you prefer.

Remember, fraudulent activity happens in a very small percentage of cases. Always offer your support to injured employees.

To order fraud posters for your workplace, call 866-206-5851 ext. 85262.

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