Fraud Investigation & Subro Programs

If You Suspect Fraud

The professionals in CIRMA's Special Investigation Unit, along with the state prosecutor's office, work diligently to protect the insurance system and our members by validating claims. Insurance fraud schemes have grown larger and more complex in recent years; staged-accident gangs and health-fraud scams are now often well-organized professional operations. Abuse of the workers' compensation system increases rates and lowers productivity.

CIRMA's prompt identification of fraudulent claims followed by timely and professional investigations, enables us to avoid making unmerited claim payments, saving you money and helping to reduce rates.

How CIRMA fights fraud.
CIRMA's SIU uses both innovative and time-tested techniques to combat Worker's Compensation fraud:

• CIRMA's claims handling system is programmed to spot suspicious trends and activity, then it automatically alerts the claims team and SIU of possible fraud.
  
  
• CIRMA employs the ISO ClaimSearch database, the only comprehensive database and system for claims processing and fraud detection.
  
  
• When there is evidence of fraud, the professionals in the Special Investigation Unit determine the most productive way to investigate and document any fraudulent activity.
  
  
• CIRMA uses skip tracing to locate witnesses and at-fault parties for all types of claims.

Experts estimate that fraud and abuse adds about ten percent to the cost of Workers' Compensation premiums across the nation. Fraud lowers work-place morale and disrupts good team-work. The entire community pays the price in the form of reduced services. Here are some important steps you can take to discourage fraud in your workplace:

• Verify references and background information during the hiring process.
  
  
• Publicize your workers' compensation policy to all new and current employees, and provide them with updates at least once each year.
  
  
• Make it known that money paid for fraudulent claims comes out of the town or school's pocket.
  
  
• Educate supervisors on Workers' Compensation issues--how injuries decrease productivity and limit your Town's ability to provide services to the community.
  
  
• Display fraud awareness posters; download PDFs below.

Fight Fraud at Work3

Subrogation Delivers Savings to Members

When it isn't the employer or the employee who is responsible for an on-the-job injury or property damage, CIRMA may pursue the party who is at fault to recover claim payments. This process is known as subrogation and is an important way for CIRMA to lower its members' claims costs.