Protecting Your School From Workers' Compensation Fraud

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1. Publish a Workplace Injury and Illness Reporting Policy
We've all known employees who suffer a seemingly minor injury at work and who brush it off, saying, "I'll be fine. I don't need to see a doctor—and I'm certainly not going to fill out Workers' Comp paperwork. It's no big deal. Really." When the minor twinge of the back becomes a larger problem, it becomes much more difficult for doctors (and insurance claims personnel) to unravel when and how the injury occurred, leading to what may quickly become a long-term absence as well as a morass of paperwork, claims denials, and the like.

This can be avoided by publishing a policy in your employee handbook that requires all injuries to be reported (commonly to the Business Office or other staff member that makes sense in your particular structure)—usually within 24 hours at the latest. Only in this way can the issue begin to be managed through proper channels. To really put the policy into effect, all supervisors (e.g., Department Chairs and above) should be trained on this policy.

2. Work Closely With Your Workers' Comp Insurance Provider
While 99.99% of your employees would never consider dragging their feet in returning to work, there are always exceptions and the school must remain vigilant. We're all familiar with stories like the following ones:

Let's say one of your food service staff, "Carol," missed a step on the stepladder she was using to reach the top shelf in the pantry. Because her hands were full, she couldn't brace herself properly, resulting in a clumsy fall that shattered her elbow. She filed for workers' compensation and disability retirement because, even after surgery, she wasn't any better and claimed she couldn't return to work. Then, six months after the incident, insurance investigators film Carol backpacking on vacation and setting up nightly campsites for herself. Carol's injury was real, however, her disability was less than permanent.

What is the solution? Are we suggesting that the school set up a "sting"—or that the Business Manager should take classes in covert investigations? Certainly not. Rather, we suggest that you work very closely with your workers' comp insurance provider throughout the process. This includes staying abreast of developments in the employee's claim, reporting any "suspicions" to the carrier, and remaining aware of the employee's expected return date. The insurance company's claims personnel are the experts—let them do their jobs, but help them by providing any and all pertinent information you may have. One person should serve as the point person with the insurance carrier (most often, this is someone in the business office)—and this person can then communicate any relevant information (such as expected date of return) to the appropriate school administrators.


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