If an employee makes a false claim about an injury in the workplace, it is considered worker's compensation fraud. When you know of an individual who is receiving fraudulent worker's comp benefits, there are several ways you can report the matter. When reporting the fraud, you have the option of remaining anonymous. However, revealing your identity can help investigators with the investigation if more information is needed to investigate the suspected fraud. In most cases, your identity will be protected under a confidentiality clause. This prevents the suspect from finding out who reported him.
Submit a written report to your state's Department of Insurance Fraud. The mailing addresses for all of the state Departments of Insurance can be found on the NAIC (National Association of Insurance Commissioners) website.
In your written report, include your name and contact information, unless you choose to remain anonymous. Include the details of the fraud, such as the name of the worker who is allegedly injured, the date of the alleged injury, why you believe the claim is fraudulent, a physical description of the injured worker and places the individual is likely to be found. If you know the claim number for the worker's comp case, include that as well.
Report the worker's comp fraud online through your state's Department of Insurance website. Some states may not have an online reporting option available. When completing the online form, include the same details as you would on the written form.
Contact your state's Department of Insurance fraud bureau hotline to report the fraud (see Resources). In most cases, a live representative is available to document the details of the fraud. If not, you may be required to leave the details of the fraud in a voice mail recording.