In order to prove Fraud, we must be able to prove the claimant intended to defraud. I'll discuss some of those tools a little later. Another element in proving workers' compensation fraud is that the person must create or reinforce a false impression that leads the insurer to pay the claim. We must show that the insurer would not have paid the claim but for the misrepresentation. There must be monetary gain or anticipation of gain.
Some states require a claim to actually be paid before pursuing prosecution for fraud.
We must be able to affirmatively identify the fraudulent party. By using fraud posters. These are displayed in visible locations at an employer location outlining what fraud is and the consequences thereof. Payroll stuffers can be used to accomplish the same thing as the fraud posters. Exit interviews are an excellent time to prevent workers' compensation fraud.