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May 05, 2016

Injured employee found guilty of fraud & required to pay back workers’ compensation benefits

Workers’ Comp 

An employee who was working as a board edger for a large wood manufacturer was injured on the job when two boards collided and one board allegedly hit the employee in the groin.

An employee who was working as a board edger for a large wood manufacturer was injured on the job when two boards collided and one board allegedly hit the employee in the groin. The injured worker was immediately taken off work by his doctor for 3 months, the injury claim was accepted by Labor and Industries (L&I), and the worker began collecting workers’ compensation time loss benefits.

As time went on and with further analysis the employer began to question exactly how the injury could have been caused in the manner the employee stated. As a member of Vigilant’s Washington retro program, the company contacted their dedicated claims manager to discuss their trepidations.

Vigilant conducted a thorough investigation which included measuring the height of the machinery and the size of the boards in an effort to recreate the injury. They also interviewed several staff members for witness statements. With the information gathered Vigilant echoed the company’s concern over the employees’ claim and contacted the Fraud Unit at Labor and Industries (L&I) to discuss the matter in detail.

Upon reviewing the report provided by Vigilant, L&I determined it was indeed necessary to launch an investigation. During the investigation the Fraud Unit obtained video of the injured worker climbing a large mountain while offering photography classes for $100 per person. As it turned out, the injured worker was conducting a side business on a rugged mountain trail, while receiving workers’ compensation time loss for a groin injury that according to his doctor “precluded him climbing, reaching and bending”.

The injured worker was found guilty of fraud for working “under the table” while receiving L&I time loss benefits. He is now responsible for back taxes to the IRS for unreported income as well as reimbursement to L&I for the benefits he received.

Workers’ compensation benefits are for truly injured employees. While many claims are valid and not fraudulent in nature, when the benefit is abused it “costs the Washington State workers’ compensation system millions of dollars each year” according to L&I, who is “serious about detecting, investigating and deterring fraud.”  If you feel your injured worker may be committing workers’ compensation fraud contact your Vigilant claims manager immediately at 425-349-4477. There are various forms of injured worker fraud including participation in inappropriate activities, working while collecting time loss benefits and claims filed under questionable circumstances. We can talk through the warning signs with you and help you assess your unique situation.

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