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PIs and Wyoming Workers’ Compensation Fraud

posted by PInow.com Staff | March 20th, 2008
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Legislators and workers’ compensation officials say they can only guess at the level of fraud and attempted fraud by workers and employers in Wyoming.

One thing they do know is how many employers don’t pay their premiums.

Some 1,621 Wyoming employers were delinquent in premiums to workers’ compensation as of the end of February for a total of more than $1.4 million, according to Gary Child, the outgoing director of the Workers’ Compensation Division. That’s more than 9 percent of all 17,718 employers who pay into the system.

Despite not paying, those employers still enjoy immunity from lawsuits, and their employees still qualify for workers’ compensation benefits.

Fraud is harder to measure. No workers and no employers have been prosecuted for trying to defraud Wyoming’s workers’ compensation system in recent years, Child said. But the agency’s internal vetting and investigating processes continually watch for phony or inaccurate claims.

Workers’ compensation spent an annual average of $229,482 on fraud investigation during the past three years, which often includes hiring private investigators to spy on workers who file claims, according to Child.

Upon request by the Star-Tribune, Child said the agency is statutorily prevented from releasing internal documentation that would demonstrate attempts to defraud the system.

Child did offer his own anecdote in an e-mail to the Star-Tribune:

“An employee filed claiming injury secondary to a minor slip, without falling, that cause(d) the need for a total hip replacement and treatment of low back pain. Evidence subsequently received revealed the hip condition and accompanying back pain was congenital and had been scheduled for surgical correction prior to the alleged work incident.”

Estimates vary about how many claims are compensable, or legitimate. Child has testified before legislators twice in recent months that he can only estimate, based on national figures, that between 10 percent and 20 percent of claims at the division are fraudulent.

The fraud estimate has been quoted by politicians who question the need for broad reform. One prominent lawmaker who has cited Child’s figures, Sen. Charlie Scott, R-Casper, acknowledged the estimate has no statistical backing.

“It was a SWAG — scientific wild-assed guess,” Scott told the Star-Tribune via email.

Worker advocates who champion reforms at Wyoming Workers’ Compensation say they’re concerned that Child and some legislators seem to be perpetuating the notion that a constant flood of fraudulent claims is overwhelming the system.

“Too many people seem to believe that workers who file claims are malingerers or worse, even crooks,” said Dan Neal, executive director of the Equality State Policy Center. “Wyoming’s boom depends on hard working labor. There may be a few who try to cheat the system. But I’d like to see better proof that it’s as high as 20 percent.”

Neal said policymakers in Wyoming don’t seem to be equally concerned about the more than 9 percent of Wyoming employers who are delinquent in their workers’ compensation premiums.

“Employers benefit a lot from the workers’ compensation system. The premiums are fair and it protects them from their own negligence,” Neal said.



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