Fraud

What do we mean by fraud? It isn't just someone faking an injury. Fraud includes infractions such as medical providers authorizing and billing excessive or uncompleted medical services, and employers falsifying payroll records to lower premiums. Most important, it's against the law.

Since 1993 our dedicated Fraud Unit has recovered tens of millions of dollars through investigative and recovery programs. We work closely with the Department of Justice to investigate suspicious activity and educate policyholders, insurance producers, and the Montana business community about detection and prevention. In addition, our claims and policy services staff are trained to detect the early warning signs of fraud.

You can help. One of the most important resources we have to combat fraud are tips we receive from citizens who believe that a fraudulent act has been committed. Use this partial list of indicators: 

Preventing fraud. Inform your employees how and when (immediately) to report accidents. Pay attention to rumors that a particular employee has indicated that he/she wants to go on workers' comp. If possible, do not let that person work alone, to prevent "unwitnessed accidents." Pay extra attention before strikes, lay offs, or seasonal closures, and to employees who are subject to disciplinary action.

What to do if you suspect fraud. Interview witnesses separately and as soon as possible. Memories are better shortly after the incident. Then, sit down with the employee making the claim. With both witnesses and employee, your goals should be these:

Document all of the above and submit to your workers' comp carrier with the fully completed Employer's First Report of Notice of Occupational Injury or Occupational Disease as soon as possible. The Department of Labor and Industry requires you to do so within six days of being notified.

Report suspicious activity by calling our Fraud Hotline: 888-MTCRIME (888-682-7463). All contacts will remain strictly confidential. Employers or designated managers or supervisors SHOULD call 1-800-332-6102.