Dayton claims rep is BWC’s Fraud Finder of the Year

A claims service specialist (CSS) in the Dayton service office received the 2016 Fraud Finder of the Year award Jan. 26 from BWC’s Special Investigations Department (SID).

The CSS received the award for alerting SID to a case in which an injured worker claimed to be wheelchair bound and unable to ambulate. Surveillance video in SID’s subsequent investigation, however, showed the claimant shopping, going to the movies and climbing steps at a football game, all without a wheelchair or assistance of any kind.

“Thanks to this CSS’s vigilance and timely referral, we were able to stop fraud in its tracks and save the BWC system tens of thousands of dollars, if not more,” said SID Director Jim Wernecke. “Our success in uncovering fraud protects scarce resources needed to create safe workplaces in Ohio and to take care of those who are legitimately injured on the job.”

The CSS, who handles permanent total disability cases, said she was delighted to receive the award.

“I was surprised,” she said. “It makes you feel good to be recognized.”

SID received 2,700 allegations of fraud in 2016, with about a fourth of those coming from BWC personnel around the state — claims representatives and others who suspect illicit behavior on the part of injured workers, employers, health care providers or others connected to the BWC system.

To show their appreciation, SID leaders conducted a thank-you tour from November through mid-February, presenting Fraud Finder Award certificates to CSSs in customer service offices across Ohio.

“We encourage all BWC employees to contact us immediately if they suspect fraudulent behavior in our system, even the slightest hint of it,” said Director Wernecke. “We will conduct a thorough investigation, and the sooner we get started, the better.”

To report suspected cases of workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov.

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