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Rise in Number of Questionable Workers’ Compensation Claims Since 2010

Written by Ankin Law Office

Workers’ compensation insurance policies are used by employers to pay injured employees workers’ compensation benefits following a workplace injury. Unfortunately, the workers’ compensation insurance industry can fall victim to insurance fraud and questionable claims just like any other types of insurance carrier.

According to this article, the National Insurance Crime Bureau (NICB) saw a 26.7 percent increase in the total number of questionable insurance claims referred to the NICB, with questionable claims increasing from 91,797 in 2010 to 116,268 in 2012. Questionable claims are those claims that NICB member insurance companies refer to the NICB for closer inspection based on one or more indicators of possible fraud.

The report looked at six categories of claims: workers’ compensation, property, casualty, commercial, vehicle, and miscellaneous claims. Overall, questionable workers’ compensation claims increased 23% from 2010 to 2012, with premium fraud showing the highest increase at 79%. Questionable workers’ compensation claims due to claimant fraud increased 37% from 2010 to 2012.

Illinois law requires all employers to carry workers’ compensation insurance for their employees.  Under workers’ compensation insurance policies, compensation and medical benefits are provided to employees who are injured on the job regardless of who was at fault for the accident or injury.  In exchange for workers’ compensation benefits, injured employees are prohibited from suing employers for workplace accidents and injuries.

Injured employees are required to promptly notify his or her employer of the accident or injury.  Generally, notice must be given within 45 days of the accident. It is important that injured employees provide detailed and accurate information to the employer so that the claim can be filed correctly without the risk of being considered a questionable claim.

If the employer fails to provide workers’ compensation benefits following an accident, the injured employee may file a claim for workers’ compensation benefits with the Illinois Workers’ Compensation Commission.  The employee – not the employer – is required to prove that he or she is entitled to workers’ compensation benefits by demonstrating that on the date of the accident, the injured worker was an employee of the employer, that the worker sustained injuries or illness as during the course of employment, the medical condition was caused or aggravated by accident, and that the employer received proper notice of the accident.

The Chicago workplace accident attorneys at Ankin Law Office, LLC focus on helping injured employees obtain the workers’ compensation benefits to which they are entitled. If you have been injured in a workplace accident, contact our office at (312) 600-0000 to schedule a free consultation with one of our Chicago workplace accident attorneys.