Fraud Articles

Understanding Premium Fraud

Until recent years, premium fraud has been a relatively invisible crime. It has been underreported by the media, and to a great extent, ignored by the business community at large. However, the impact of premium fraud on your business is very real. Premium fraud is a crime. It jeopardizes workers’ rights to health care. It fosters unfair competition. And by raising premiums, it punishes employers who play by the rules. Here’s how you can identify premium fraud and what you can do about it. What is premium fraud?  According to the Labor Research Association in New York* for every $1... Read More

Preventing Premium Fraud is Everybody’s Business

From an employer’s view, it’s easy to see the negative financial impact caused by claimant fraud. If an employee makes false statements regarding the circumstances or seriousness of an injury, the fraudulent claim can result in lost productivity and higher premiums—consequences that directly affect your bottom line. Premium fraud can be much less obvious—and even more financially devastating. For example, let’s say you own a construction business. Your success relies upon your ability to provide competitive estimates for each job you bid on. If you payroll a crew of 15 journeymen, you’ll pay workers’ compensation premiums according to their job... Read More

Why does HEMIC emphasize fraud prevention?

Fraud hurts honest employers and employees. Every time an employer or employee cheats the workers’ compensation system, honest employers pay the bill. Many people think they are cheating some big insurance company. However, fraud costs are passed on to employers as part of the premium they pay. Every dollar that the employer wastes because of workers’ compensation fraud is a dollar that could be used to make workplaces safer, improve employee benefits or wages, hire more employees, or just survive and compete in a competitive economy. Fraud can be contagious. If an employer loses a bid to a competitor who... Read More

Employee or Contractor? The 20-Factor Test

Workers’ Compensation, unemployment insurance, the IRS… They all must make determinations regarding whether workers are employees or independent contractors. Different tests are used by the various organizations, but they all have a common theme. The bottom line is that if a preponderance of the information indicates the worker is an employee it doesn’t matter what title has been assigned by the employer. An employee, by any name, is still an employee. In each of these 20 areas, the first statement applies to employees, while the second applies to contractors. Twenty-Factor Test ISSUE EMPLOYEE INDEPENDENT CONTRACTOR 1. Instructions • Required to... Read More