While my last article said it “appeared” the new worker compensation legislation (HB 2137) is a positive step overall, it also pointed out the business community was concerned the legislation was lopsided in favor of the claimant. One such example is the section regarding fraud, Section 25.5.
In the staffing industry, worker compensation fraud is an enormous problem. Our industry, along with a few others, is targeted for this type of fraud. There are many reasons for this: short-term employees, some difficulty accomplishing detailed accident investigations, etc. Regardless, our industry spends a lot of time and money combating fraudulent claims, even when they’re dismissed. It’s an aspect we train and focus on every day.
Worker compensation legislation in Illinois really hasn’t had fraud provisions with any teeth. Therefore, in the agreed bill process undertaken in 2005, the governor requested that fraud reform be a major focus. The business community agreed, and their representatives asked for strong fraud provisions in the new legislation. As is often the case, such requests get watered down. Though the new legislation has more focus on fraud, it’s mainly misdirected.
Section 25.5 of the new act states that it’s unlawful for any person, company, corporation, insurance carrier, health care provider, or other entity to:
• Intentionally present any false or fraudulent workers’ compensation claim.
• Intentionally make any false or fraudulent material statement or material representation for the purpose of obtaining or denying any workers’ compensation benefit.
• Intentionally make any false or fraudulent statements with regard to the entitlement to workers’ compensation benefits with the intent to prevent an injured worker from making a legitimate workers’ compensation claim.
• Intentionally prepare or provide an invalid, false, or counterfeit certificate of insurance as proof of workers’ compensation insurance.
• Intentionally make any false or fraudulent material statement or material representation for the purpose of obtaining workers’ compensation insurance at less than the proper rate.
• Intentionally assist in any of the above.
After reading this section, who do you believe the labor-driven leaders of this legislation think are the main fraud concerns in Illinois? It’s certainly not the claimants. Unfortunately, it’s the employers who feel they’re under assault again.
The fraud provisions in the new legislation are just one example of what makes the business community members shake their heads with frustration regarding Illinois worker compensation. Though many believe it was probably the best deal employers could get, they aren’t necessarily happy with it. What they want is the pendulum to take a hard swing back to balanced legislation. What they know is it won’t happen until there’s a change in the Illinois political climate. IBI