by Lindy Z. Kerr, Esq.

An article in the AJC last week reported how a supervisor with the State’s HERO Unit was arrested and charged with felony insurance fraud in connection with his workers’ compensation claim. The HERO Unit is the metro Atlanta Highway Emergency Response Operations Unit, which patrols local freeways to offer stranded motorists assistance with relatively minor issues such as flat tires and empty gas tanks in an effort to keep traffic flowing. The employee claimed he injured his knee falling out of a HERO truck; however, an investigation by the Enforcement Division of the State Board of Workers’ Compensation revealed he was injured performing an agility test as part of an application for another job. The employee also faces two counts of making false and misleading statements for the purpose of obtaining workers’ compensation benefits. At the time the article was published he was being held in Fulton County jail.

The article did not go into the details of how the Enforcement Division was tipped off. However, many times it is a spouse, co-worker, friend, or supervisor who either notifies the Enforcement Division or the insurance carrier of possible employee fraud. Other times surveillance uncovers fraudulent behavior. Maintaining good communication between the employer, insurer and defense counsel increases the likelihood fraudulent behavior will be uncovered and investigated appropriately. In the case reported in the AJC, the employee was charged with lying about his injury, but insurance fraud would also include staging accidents, faking an injury, working and receiving benefits, and identity theft.

The Enforcement Division has a fraud hotline for reporting employee fraud or employer non-compliance: 1-800-533-0682.