Home > Fraud Awareness, SID Information > Double Dipping: Working While Receiving Disability Benefits

Double Dipping: Working While Receiving Disability Benefits

While it goes by many names (compensation, indemnity, lost time, disability, etc) the benefit is the same: an insurance to pay claimants an income while they are unable to return to work due to a work-related injury or illness. Unfortunately, individuals take advantage of our system and fraudulently receive these benefits.

Known to us as “work/comp”, working while receiving compensation is our second most common complaint type. This type of claimant fraud occurs when a claimant covertly returns to work, either with an employer or by engaging in self-employment, while he or she is receiving a benefit that is paying for their lost wages and prohibits any employment. It often involves a scheme that conceals the conflict employment from BWC and the claimant’s physician, who requests benefits for the claimant.

A Case In Point

We received an allegation that a claimant owned and operated a business in Arizona while receiving lost time benefits from BWC. Our investigation revealed the subject owned and operated a home restoration business in Sierra Vista, Arizona. The evidence we secured included reports documenting the subject was found guilty in Arizona on three occasions of operating his business without a contractor’s license. Our evidence also included 149 checks written by customers to the subject. In all, we identified $419,357 in cash and checks the subject received for his active work as a contractor.

The BWC SID Fugitive Task Force coordinated the subject’s arrest at work by the Cochise County (Arizona) Sheriff’s Department. The U.S. Marshalls Service extradited the subject back to the State of Ohio.

On February 28, 2011, the subject pled guilty to one fifth-degree felony count of workers’ compensation fraud. The court sentenced the subject to serve 12 months of incarceration (suspended) and five years of probation. The court ordered the subject to pay BWC $64,273 in restitution and $2,727 investigative costs.

Be on the Lookout

Red flags that may indicate a claimant is working while receiving include:

  • Claimant uses alias names;
  • Claimant has calluses on hands, grease under fingernails;
  • Claimant wears a work uniform;
  • Claimant drives a work vehicle;
  • Claimant leaves homes early in the morning and returns home in the evening; and
  • Claimant relocates out of state or country after filing the claim.

If you suspect that a claimant is working while receiving, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

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