For over 10 years, Bruce Gilbert and his wife, Alice ran a workers compensation insurance fraud scheme that paid them over $700,000.
That's a very long time to collect workers compensation benefits fraudulently and it's quite a large sum to have to pay back when you get caught.
Still, some employees, business owners and even some doctors and lawyers plot against workers compensation insurance companies to get money for nothing.
For Bruce Gilbert, the only work he had to do for nearly 10 years was to talk to investigators like a 5 year old. He even went as far as to tell the investigators that his favorite foods were "Pizza and spaghetti" and that his favorite books were "about animals".
He and his wife claimed that he had a regressive mental ailment that gave him the mental capacity similar to that of a toddler.
During the time that Bruce thought he wasn't being watched, he would drive, golf and even hunt, until the day he was arrested.
A golf course in Columbia county, Fl.
He and his wife were each placed on 15 years probation and ordered to pay back the $774,000 they received illegitimately.
This story highlights the massive problem of workers' comp fraud. According to the National Insurance Crime Bureau, workers compensation insurance fraud costs businesses $30 billion annually.
The Coalition Against Insurance Fraud says all types of insurance fraud cost the average American household about $950 a year.
The most common type of Workers' Compensation Insurance fraud is claim-related fraud
The definition of claim-related fraud - when an employee attempts to gain a workers' comp benefit by falsely stating an injury or illness occurred at work or by exaggerating an existing injury or illness.
Top 10 Most Common Workers Comp Insurance Fraud Warning Signs
Workers' Compensation Insurance companies see a lot of fraud, and because of that these companies can also see the trends and signs that most commonly happen when someone or a group of people are trying to scam a workers compensation insurance company.
Here are 10 common "red flags" to look for when an employee is trying to commit workers' compensation fraud.
1. Monday morning injury reports - injury occurring first thing monday morning or lat on friday afternoon but not reported until monday
2. Employment change - immediately before or after termination, layoff, end of a big project or conclusion of seasonal work
3. Suspicious providers - medical providers or legal consultants have a history of handling suspicious claims, or groups of claimants using the same doctors and lawyers
4. No witnesses - there are no witnesses to the accident.
5. Conflicting descriptions - the injury report or medical history don't match the employee's description
6. History of claims - claimant has a history of making suspicious claims
7. Treatment is refused - claimant refuses a diagnostic to confirm the nature or extent of an injury
8. Late reporting - employee delays reporting injury or claim without a reasonable explanation
9. Claimant is hard to reach - they injured employee is hard to reach at home
10. Changes - claimant changes jobs, addresses and physicians frequently
If an employer notices that two or more of these red flag behaviors and begins to suspect that an employee may be committing claim-related fraud, they should report the behavior immediately to their workers' compensation insurance carrier.