Workers Compensation Fraud
Texas Mutual Has a Zero Tolerance Fraud Policy
Fraud steals money from the workers' compensation system and honest employers like you. Texas Mutual Insurance Company works hard to stamp it out, but we need your help.
Recent Workers Comp Fraud Headlines:
Workers Comp Fraud isFraud is lying for financial gain. Claimant fraud is the most common type of fraud. Claimant fraud happens
• Fake or exaggerate injuries
• Collect benefits for injuries that were not work-related
• Double-dip, or continue to collect benefits after returning to work
• Engage in activities that are inconsistent with their injuries
Fraud is not
Some injured workers take longer than expected to recover and return to work. This is not fraud. Injured workers do not have to return to the job until their treating doctor releases them.
Recreational activities. Injured workers can participate in recreational activities that are consistent with their medical restrictions.
Suspicion without evidence. To prove fraud, Texas Mutual Insurance Company must have evidence that the injured worker knowingly collected benefits he or she was not entitled to. Evidence includes medical records, witness testimony, business records and surveillance video.
Texas Mutual's role in fighting Workers Compensation Fraud
Unlike some insurance carriers, Texas Mutual Insurance Company does not accept fraud as a cost of doing business. We dedicate the resources necessary to fight it. Our three teams of seasoned in-house investigators prevent millions in fraud every year.
Your role in fighting Workers Compensation Fraud
Educate your employees. Teach them that when they commit fraud, they don't just cheat the insurance carrier; they cheat their employer and their co-workers. Make it clear that the company has zero tolerance for fraud. Visit the Fighting Fraud section at www.texasmutual.com for a free Fraud Stoppers poster.
Report your suspicions. Learn the red flags for fraud (see below), and email us at email@example.com or call (800) 488-4488 to report suspicious activity. Cooperate with our investigators. Notify us of new information in a case, attend hearings when requested and allow employees to testify.
Red flags for Workers Compensation FraudContact us immediately if you identify two or more of these indicators in a claim:
- Tip from a credible source
- New or disgruntled worker
- No witness to alleged injury
- Inconsistent or illogical description of incident
- Injured worker difficult to contact
- Injured worker acts upset when contacted
- Suspicious injury that happens on Monday or Friday
Our Fraud Stoppers program offers potential cash rewards for tips that lead to arrests and indictments. Email us at firstname.lastname@example.org, or call us at (800) 488-4488. We will maintain your confidentiality whenever possible.