Workers' Compensation

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.

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

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: 

  • The alleged injury occurred late on a Friday, or early Monday, and not reported until the following Monday.
  • The accident occurred just prior to a strike, job termination, layoff, at the end of a project, or at the end of seasonal work.
  • The accident was not witnessed by fellow employees.
  • The claimant has a history of previous claims.
  • The claimant delays reporting the accident.
  • The claimant has recently purchased disability policies.
  • The time of accident was outside normal working hours or on a Saturday or Sunday.
  • The claimant's attorney notifies you of the injury.

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:

  • Get a complete accident description.
  • Determine which part of the body was injured.
  • The facts: when did it happen, who was involved or who was a witness, what caused the injury, how did it happen, where did it happen, and why did it happen?
  • Ask the witness to verify what you wrote down, or ask them to write their own observations, and sign and date the report.
  • Determine if it was physically possible to have sustained the injury in the fashion described. If you have doubts, advise us accordingly.
  • If an accident is not immediately reported, ask for a detailed explanation.

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.

For more information, view our Fraud Brochure