Case File When a carrier accused a bricklayer of concealing prior injuries, the Workers' Compensation Board found the evidence failed to establish that the prior insurance claims actually involved the claimant. Case Matter of Loja-Saula […]

Back to Claims School A strong fraud investigation begins long before anyone is caught doing anything. It begins when a claims professional recognizes that the available information requires closer examination and responds with discipline. The […]

Back to Claims School Fraud concerns often begin with a detail that needs clarification. A date may conflict with a medical record, an activity may appear inconsistent with a stated restriction, or a billing pattern […]

What Do You Think? When a claimant tries to claw back what he thinks is his several years after a decision against him came down, the record -- including recordings -- may come back to […]

Glossary Check Workers' compensation fraud might be the kind of thing that you think you know when you see, but state law usually has a definition for it. That's the case in Hawaii, which, as […]

Workers compensation fraud accusations are one of the most aggressive tactics insurance companies and employers use to avoid paying what they owe. This case is about exactly that. In April 2026, I argued a case […]

Case File When a workers' compensation claimant indulges in fraud, he forfeits his right to obtain benefits, but is the forfeiture retroactive or only after the misrepresentation was made? Case Cousain v. Smitty's Supply, Inc., […]

Fraud Watch Fraud in workers’ compensation brings up concerns such as exaggerated injuries, provider schemes, premium manipulation, or claim-related dishonesty. A growing scam targeting Spanish-speaking injured workers now asks the industry to widen that lens. In these cases, criminals […]