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April 22, 2021 Claims Services

Caught in the Act

Beacon Mutual recently identified an injured employee who was collecting workers' compensation benefits, while  also working a second job.  Beacon's fraud prevention team caught the employee in the act! Unfortunately, this type of claims fraud is one of the common ways an employee tries to scam the system. Identifying this behavior and closing the claim resulted in a success for both the policyholder and for Beacon who saved the policyholder over $20,000 in fraudulent benefits. 

Claims Fraud: A Success Story

This case involves a 37 year old who initially sustained an injury to his back while working for our policyholder. As the claim progressed, and due to the diligence of our claims team, we learned that the employee was working while collecting workers’ compensation benefits. 

Through surveillance and documented Facebook posts regarding the claimant's employment, we were successful in suspending the payment of indemnity benefits at the Workers’ Compensation Court. 

The case was referred to the Workers’ Compensation Fraud & Compliance Unit who, in turn, after extensive review and follow up, referred it to the Attorney General’s office. The case was recently prosecuted in Providence Superior Court where a final disposition was rendered. The employee/defendant pled to obtaining money under false pretenses over $1,500.00 and one (1) count of Workers' Compensation Fraud. He was sentenced to 5 years suspended probation and was ordered to pay $6,985.54 in restitution.

The thorough and complete investigation by Beacon's claim representative, the efforts of our fraud prevention team, and our strong partnership with the Workers' Compensation Fraud & Compliance Unit and the Attorney General's office, lead to this great result. 

Workers’ compensation fraud is a crime.

Under Rhode Island law, workers' compensation fraud is punishable by civil and criminal penalties, including imprisonment. At Beacon Mutual, we take workers’ compensation fraud very seriously, and we are committed to being part of its solution. Beacon Mutual offers expert advice on handling workers’ compensation claims and issues of fraud. All Rhode Island workers’ compensation issues are heard at the Workers’ Compensation Court by the filing of a petition, but only a fraction of petitions involve Beacon policyholders. Beacon is there to protect policyholders and make sure that they are represented in RI Workers’ Compensation Court when needed. If you suspect someone of fraud, visit Beacon's Fighting Fraud website.

Resources:

  • Beacon Mutual works closely with policyholders to resolve workers' compensation policy and claim issues and to avoid litigation. Read Beacon's news about RI Workers' Comp Court Claims.

  • To learn about the types of workers' compensation fraud, or to report fraud, visit Beacon Mutual's Fighting Fraud website.

  • For more information about the Rhode Island's workers' compensation laws, visit the Rhode Island Workers' Compensation Court website. 

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Todd Graham
Written by

Todd Graham

SR CLAIMS INVESTIGATOR

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