Just for Employers

Fighting Fraud

fraud contact info

Your peace of mind is our priority

When workers' compensation fraud occurs, it's harmful to employers and raises costs for all over time. That's why we have dedicated fraud teams that investigate every case reported and identify millions of dollars in workers' comp fraud each year. Your peace of mind — and your bottom line are their top priority.

What you can do

Fraud comes in many forms. As an employer you can be aware of the signs and take action to prevent it in your business. See our recommendations for fighting workers' comp fraud in your business.

What you need to know about fraud: seven red flags and 10 prevention tips

What fraud looks like

There are three main types of workers' compensation fraud. Read about each below and find tips for protecting your business from them.

Claimant fraud happens when workers:

  • Fake or exaggerate injuries
  • Collect benefits for injuries that were not work-related
  • Double-dip (continue to collect benefits after returning to work)
  • Engage in activities that are inconsistent with their injuries

Read more about claimant fraud

Health care fraud happens when providers:

  • Bill for services or goods not received
  • Up-code (submit codes for more serious diagnoses and expensive procedures)
  • Unbundle (bill for multiple procedure codes that are covered by a single comprehensive code)
  • Provide unnecessary treatment, supplies and tests

Read about health care provider fraud

Premium fraud happens when policyholders or agents:

  • Underreport and/or hide payroll
  • Misrepresent contract labor employees as subcontractors
  • Misrepresent the type of work performed
  • Create a new company to obtain a lower experience modifier

Let us know if you suspect fraud

Our fraud teams are ready to help, and those who report fraud could receive a reward of up to $1,000. To report suspected fraud, email us at fraudstoppers@texasmutual.com or call (800) 488-4488. 

What to include when you report:

  • Name of individual, employer, health care provider, attorney or medical facility
  • The city in which they are located
  • Reasons you suspect fraud

Help your employee get back on the job

Implement a return-to-work program to help workers get back on the job.

Prevent accidents in your workplace

To control workers' comp costs, reduce safety risks.