Why Employers Must Fight Workers’ Comp Fraud and Advocate for Injured Employees

Workers’ compensation fraud is real. Anyone who has worked in HR or risk management has seen it often enough that skepticism becomes almost automatic. 

That skepticism is exactly why this story matters. 

I once had an employee, I will call him John, who was seriously injured while doing his job. 

John’s Injury 

John was a mechanic working on a large property. One day, while driving a golf cart near the on-site post office, the cart stalled. He got out to see if he could identify the problem and possibly repair it. 

As he bent over the golf cart, an elderly resident who was there picking up her mail, got in her car, and put her large Buick into reverse without ever looking back.  She pinned him between her car’s rear bumper and the golf cart.  Instead of stopping, she continued to accelerate.  His screaming finally got her attention and she stopped. 

He was fortunate to survive. However, he sustained a significant back injury and crumpled to the ground. Fortunately, there were others in the area who responded immediately and called 911.  They responded swiftly and transported him to the hospital. 

The injury was reported immediately to the workers’ compensation carrier. 

When a Real Injury Is Still Questioned 

The next day, I spoke with the claims adjuster. Both of us were experienced professionals. Both of us had dealt with fraudulent workers’ compensation claims on a regular basis.  That experience created an unspoken hesitation. 

I found myself having to clearly state something that should have been obvious. This was a legitimate injury. This was not someone attempting to abuse the system. This was an employee who was seriously hurt while performing his job duties. 

That conversation stayed with me, not because the adjuster was unprofessional, but because it highlighted a larger issue. In a system shaped by fraud, even obvious injuries can be met with doubt. 

What Advocacy Looked Like in John’s Case 

Advocacy did not end with filing the claim.  It meant following up with the carrier to ensure the claim was handled correctly. 

It meant checking in with John to make sure he understood the process, was receiving appropriate medical care, and that he was not falling through the cracks.  It meant providing the carrier with his wage information so that payments could be made to him while he was out of work.  Everyone needs their pay check and going without it can make the difficult situation of a workplace injury even worse. 

It was a long road for John, but he was finally able to return to work.  This meant reinforcing expectations.  The goal was always to help John heal and return to work safely. That required clear communication about light duty restrictions and his responsibility to follow them so his recovery was not delayed or made worse.  Support and accountability had to exist at the same time. 

Why Responsible Employers Stay Involved 

Responsible employers do not report an injury and then step away. They remain engaged throughout the process.  That engagement benefits everyone. 

For the employee, it provides clarity, support, and a faster path back to full wages and normalcy. For the employer, it reduces lost time, controls costs, and helps avoid unnecessary disputes. 

Return to work is not just a financial objective. It is a recovery strategy. Light duty assignments allow employees to stay connected while healing. At the same time, employees must understand that following medical restrictions is not optional. It is a critical part of recovery and risk control. 

The Real Risk in Workers’ Compensation 

Fraud is a real concern. But it is not the only risk.  Failing to advocate for legitimately injured employees creates its own exposure. Delayed recovery, increased costs, legal claims, and loss of trust often follow.

John’s situation reinforced an important truth. Employers can fight fraud and still stand up for employees who truly need help. In fact, the best employers do both. 

Workers’ compensation is not just a claims process. It is a reflection of leadership, culture, and values.  And sometimes, it starts with making sure a real injury is treated like one.

If you want to strengthen your workers’ compensation practices while protecting both your employees and your organization, I can help you evaluate your current processes, identify risk gaps, and build a more effective approach to injury response and return to work.

👉 Contact me to start the conversation.