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Losses resulting from Workers’ Compensation
fraud and abuse affect every business. Compensation fraud
may originate with claimants who make false statements in
order to qualify for benefits, with medical providers who
submit bills for services not rendered or with employers who
deliberately falsify payroll information. No matter what the
source or origin, Lovell Safety Management is committed to
uncovering, eliminating and prosecuting fraudulent practices.
Studies have shown that between 10% and 25%
of all Workers’ Compensation costs involve fraud or abuse,
and that less than 20% of abuse cases are identified. This
means that every employer is forced to cover the cost of Workers’
Compensation dollars lost by fraud. But, at Lovell, our mission
is to ensure that our Group members are securing coverage
at the lowest possible cost. So, we recognize our responsibility
is to aggressively pursue investigations into any suspected
cases of fraud or abuse. And the record points to our success.
Below are examples of several controverted cases
where Lovell’s thorough investigations revealed abuse
and resulted in decisions that protected and/or benefited
our Group members.
| Claimant Alleged |
Shoulder injury sustained
while transferring a patient from a geri-chair to a bed.
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Findings of Lovell Investigation
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Injury was the result of a prior incident, any claim
for which was prevented by the statute of limitations.
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| Decision |
Claim disallowed. Case closed.
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| Claimant Alleged |
Pain in right knee stemming
from work duties |
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Findings of Lovell Investigation
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No prima facie medical evidence, possible link to prior
football injury.
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| Decision |
Insufficient evidence of occupational injury or disease.
Case closed.
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| Claimant Alleged |
Development of occupational
asthma due to exposure to colophony fumes. |
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Findings of Lovell Investigation
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Previous medical history of mold allergies, chronic
nasal congestion and sinus symptoms.
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| Decision |
Award reduced in part because of prior medical history.
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