FRAUD
An intentional deception for the purpose of financial gain.
or individual
LWCC covers only Louisiana businesses and organizations
workplace safety
Guaranteeing your workplace is as safe as possible for your workforce is the best way to minimize risk and decrease chances of workplace injury.
system of free resources
A vast online library of regularly-updated safety resources, tools, and references made available to policyholder for free.
safety experts
LWCC’s Consultants on Call are dedicated to understanding your operations and customizing safety solutions to meet your needs.
mutual insurance company
We are mandated to serve the mutual benefits of its members.
personalized service
Our Agency Relations Representatives are available to partner with you to serve your policyholders through in-person or virtual visits, depending on your preference.
underwriting team
Specialized team with in-depth knowledge of the unique needs of companies of various sizes and specialties.
tools and information
The team assists agents in connecting to relevant department contacts, as well as resources, tools, guides, and educational materials available from LWCC.
dedicated agent resource
LWCC Agency Relations are here to serve agents and their staff only.
compassionate care
Genuine compassion requires the experience to know what matters and what help is actually needed.
plan development
WorkAction plans are customized to the injured workers’ needs by vocational rehabilitation specialists.
early intervention
Our WorkAction return-to-work program capitalizes on the window of opportunity right after an employee is injured to help create a return-to-work plan that works for you.
return-to-work program
Our experienced team helps design the right program for individual claims, or assist you in creating a proactive program to safely get your employee back to work — all at no cost.
quality medical care
Including hospitals, clinics, specialists, pharmacies, physical therapists, chiropractors, diagnostic testing, durable medical equipment vendors, rehabilitation, and home healthcare providers.
skilled providers
LWCC has selected providers across the state based on their expertise in occupational medicine, professional credentials, use of established treatment guidelines, and effective return-to-work practices.
prompt access
With OMNET®, injured employees are guaranteed appointments with specialists on a priority basis.
statewide
The first of its kind in Louisiana, OMNET includes providers across the state, even in rural areas.
strong financial results
The dividend program is made possible by the sound counsel of our agent partners, our employees’ dedication to excellence in execution, policyholders’ continued commitment to safety, a strategic approach to investment and risk management, and guiding principles that keep us focused on planning and preparing for the unexpected.
policyholders
Returns are maximized by long-term policyholders who become fully vested in the dividend program.
shared
A unique benefit for policyholders of a mutual insurance company.
workers’ compensation related
Provide a broad range of litigation services in the workers’ compensation arena.
provides counsel
The team handles cases of all sizes, regardless of the complexity of the dispute at issue.
in-house legal team
The Johnson, Rahman & Thomas team has approximately 19 lawyers, paralegals and legal assistants.
correct premium
Per the policy, the final premium is determined after the policy ends by using the actual premium (validated at the audit), along with proper classifications and rates.
charged
The amount of premium due.
opportunity
The audit is an important step in the workers’ comp insurance process.
financial gain
Can include paid benefits, unnecessary treatment or prescriptions, misrepresenting business details, and more.
intentional deception
Deception by a member of the workforce, a company leader, or a healthcare provider.
fully protect
Workers’ compensation is a form of insurance providing wage replacement and medical benefits to employees injured on the job.
assist employers
Agents solicit and negotiate insurance contracts for the best fit between an insurer and a business or organization.
valuable resource
LWCC does not write workers’ comp policies directly with employers. We are proud to partner with agents across the state to provide outstanding service to our policyholders and their workers.
business, organization,
LWCC covers only Louisiana businesses and organizations
insurance policy
Our focus always has and always will be workers’ comp insurance
business or individual
LWCC covers only Louisiana businesses and organizations
injured workers
LWCC understands the difficulty of being injured on the job and is there to help those requiring assistance in recovery and return to work.
workers’ compensation
A form of insurance providing wage replacement and medical benefits to employees injured on the job.
private, nonprofit
We are mandated to serve the mutual benefits of our members.
evaluate corporate performance
The broader impact a company is having on the community and the world.
Non financial factors
Environmental, social, and governance
safety resources
Training, information, and experienced professionals made available to policyholders to prevent workplace accidents and improve overall workplace safety.
Types of Workers' Comp Fraud
Workers’ comp fraud can happen in numerous ways. No matter what type of fraud, we all pay. Here are just some forms of fraud.
Injured Worker Fraud
Faking or intentionally causing an injury
Claiming an injury that was not work-related
Secretly working for another employer or oneself, or returning to work while collecting benefits
Misrepresenting the seriousness of an injury
Lying about the amount of lost wages
Secretly filing multiple claims for the same injury
Company/Business Fraud
Underreporting payroll to pay lower premiums
Misclassifying employees to pay lower premiums
Lying about business operations
Hiding past losses
Not carrying workers’ comp insurance as required under the workers’ comp act or falsifying proof of such coverage
Healthcare Provider Fraud
Falsifying the nature of an injury or diagnosis
Unnecessarily prolonging treatment or the period of disability
Intentionally billing for services that were not rendered
Fraud Reporting Rewards Program
LWCC’s Fraud Rewards Program rewards anyone meeting the eligibility requirements who provides information on suspected workers’ compensation fraud against LWCC that leads to an arrest. The eligibility requirements are as follows:
A reward of $1,500 will be given to an informer who supplies information leading to the arrest of anyone defrauding LWCC. The reward will be presented only after an arrest is made.
Tipsters must give their name and address. This information will not be released without written permission or a court order. Of course, outside of the reward program, anonymous tips are always accepted.
LWCC must be the insurance company involved.
Decisions to investigate tips will be made based upon the quality of information received.
If the case is already under investigation, the tip must supply new substantive information that furthers the successful completion of the investigation.
LWCC policyholders (owners, officers and principals), Insurance agents, and LWCC employees, and their families are not eligible for the rewards program.
In the case of multiple reports on the same case, LWCC will present the reward to the first substantive report. LWCC’s decision in this regard is final.
How to Prevent Workers’ Compensation Fraud
- Investigate all accidents.
- Implement sound investigation techniques that can help you correct any hazardous conditions contributing to an injury and uncover any signs of possible fraud.
- Review video surveillance of the accident scene if available.
- Separate witnesses and interview them as soon as possible following an accident.
- Discuss workers’ compensation policies and procedures, including what employees should do if they are hurt on the job.
- Inform employees that workers’ comp is there to help employees who are injured but fraud is a crime that LWCC will prosecute.
- To prevent off-the-job accidents from being filed as workers’ comp claims, explain to employees how short-term disability works if you offer that benefit.
When employers have transitional duty available for employees, committing fraud becomes less tempting.
- Conduct criminal background and drivers’ license checks before hiring new employees.
- Verify references and information listed on job applications.
- Your safety program should include regular inspections of the work area and equipment.
- Fix any hazards immediately and document all checks and repairs.
Click here for more information on developing your own written safety plan
To discourage post-termination claims, part of your exit interview should include a signed statement from the employee as to whether or not he/she experienced any unreported injury at work.
According to the National Insurance Crime Bureau, a claim might be fraudulent when two or more of these signs are present:
- Following the accident, rumors spread amongst employees about possible foul play.
- An unusually long time passes before the claim is reported, especially if the injury is serious.
- The employee can never be reached at home or on a mobile phone.
- The employee switches doctors after being released to work.
- The employee’s story of the accident changes.
- No one witnessed the injury.
- The claim is older than three months, and...
- the accident occurred on a Friday afternoon or Monday morning;
- the accident happened just before a strike, layoff, termination, or the end of seasonal work; or
- the accident happened outside of the employee’s normal working hours.
If any of these indicators exist on a claim being handled by LWCC, please notify the Claims Representative so he/she can investigate further.
Fraud Reporting Options
If claims activity related to workers’ compensation fraud is suspicious, the following options are available for reporting.
Call LWCC’s toll-free Fraud Hotline
Call to report suspicious claims activities. Concerns and fraud prevention questions will be answered directly by an LWCC special investigator.
Online Fraud Reporting Form
If you would like to report someone who you think may be committing workers' compensation fraud, complete the information in this form. You may choose to submit this information anonymously; however, this may limit the scope of the investigation. If you need to report fraud on a claim not being handled by LWCC, or a policyholder not insured by LWCC, please report it directly to the Louisiana Workforce Commission.
* This form is for Louisiana only. If you would like to report workers' compensation fraud in a state other than Louisiana, please contact the desired state's workers' compensation office or website.
Our Fraud Investigation Practices
LWCC’s special investigation unit (SIU) collaborates with the claims teams to help mitigate exposure to determine which claims warrant further investigation and SIU intervention. Where indicated, LWCC will submit fraudulent files for criminal prosecution.
