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WORKERS’ COMP WORKING TO CUT DOWN ON FRAUD

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Watching 1967 reruns of "Dragnet" partially prepared me for a session with a person from a surveillance company hired by the Workers Compensation Fund of Utah to gather evidence as part of the fund's ongoing effort to reduce workers' compensation fraud.

There I was. Sitting in a car with a surveillance company employee waiting for someone to leave a westside Salt Lake house and go to work. The person wasn't supposed to be working since the individual was receiving benefits from the fund.Holding sack on the house for more than two hours isn't the glamorous job many people believe, but it's another way the fund is attempting to stop fraud that costs all of the policyholders money in the form of increased premiums.

The videotaping and observation by surveillance people is part of the effort used by the fund's Special Investigations Unit that has resulted in saving the fund $6 million since the unit was organized in 1993, according to Joel Campbell, a retired police officer who directs the unit.

In an effort to educate the public about workers' compensation fraud by employees and employers, the fund has started an advertising campaign. One of the television spots shows a man getting mugged by three young men with the idea that everyone gets robbed every day because of fraud.

The other spot shows a person who receives workers' compensation benefits because of a bad back lifting heavy items. It later shows him sitting in a prison cell because of a fraud conviction.

Campbell said tips on workers' compensation insurance cheaters come from fund adjusters, people calling the fraud hotline and from policyholders (employers). Once unit investigators have looked at the situation, they occasionally hire one national surveillance company or one of five local ones to provide videotape or other evidence against the company or person.

He said outside firms provide an objective look at a fraud situation and the people also can testify in court, if necessary. Campbell said the unit has almost a 100 percent conviction rate.

Tom Callanan, vice president of marketing for the fund, said his organization used to have a contract attorney who took the cases to the Salt Lake County Attorney's Office for possible prosecution. But since the State Insurance Department established a fraud unit, the cases are screened at that level and then taken to the Utah Attorney General's Office.

Since 1992, fund investigators have 46 criminal convictions and there are 22 cases pending. So far this year, 15 people have been convicted, compared with 11 for all of 1994. Callanan said 99 percent of the people in Utah are honest about workers' compensation, but his SIU deals with the small percentage who are not.

Callanan said employees commit fraud by collecting benefits for an injury and then going to work at another company; claiming they are injured but performing tasks that show they aren't injured; and getting injured at home and then claiming to have been injured on the job.

Employer fraud is the result of a company understating the size of its payroll (premiums are based on the size of payroll and the type of working being done by the employees). In some instances, said Callanan, employees take out workers' compensation insurance under another company name and let the old policy lapse.

In another scenario, some companies conspire and get an insurance policy for all of them in violation of state law, which says all companies must have separate policies.

Callanan said the WCFU has taken the lead in the United States in prosecuting workers' compensation fraud and also has the lead in the amount of money being saved because of the deterrent effect of the prosecution.