Fraud usually involves six elements:

• False information given by an insured employer, an injured worker, a witness, another person involved in a claim, an insurance company or a claims adjuster working for an insurance company.
  
  
• The false information is spoken or put in writing.
  
  
• The person who gives the information knows it's false.
  
  
• The false information is meant to prove, validate, affirm or deny a claim for injury or loss payment, or to obtain insurance coverage.
  
  
• The false information must be given with intent to defraud.
  
  
• The false information must relate to the case (i.e., change the way the claim was handled, investigated, evaluated or settled).

No. The definition varies by state. In most states, however, the law applies to any person, including insured employers, insurance companies, injured workers, doctors, claims adjusters and others involved in a claim.

Workers' compensation fraud not only impacts the insurance company that pays the false claim, but it can also raise your insurance cost. This in turn harms your customers because the higher premium you must pay for insurance gets passed onto them.

To report potential fraud, please call 1-866-296-4748. You can also send an email to fraud@thezenith.com.

The four most common types are:

1. Employee fraud: Worker knowingly files a claim for an injury that did not occur on the job, or the worker misrepresents facts to receive greater benefits.
   
   
2. Medical fraud : Medical provider bills for services not provided, intentionally inflates charges for services, or bills for services provided by non-licensed or unqualified personnel.
   
   
3. Premium fraud: Employer intentionally underreports the number of claims, the number of employees or amount of payroll, or misclassifies employees to affect the price of coverage.
   
   
4. Employer fraud: Employer denies benefits to an employee by not reporting a claim or encouraging employees not to report a claim.

Contact your claims adjuster. Or call Zenith's Fraud Hotline at 1-866-296-4748. Have the following information handy:

• Claim number;
  
  
• Policy number;
  
  
• Your phone number so Zenith personnel can call you back, if necessary;
  
  
• Employee's name;
  
  
• Employee's physical description; and
  
  
• Location and specific activities that were observed.

Zenith recommends that you let us investigate Zenith claims. We work with licensed, insured professionals who know local laws and ordinances pertaining to the lawful investigation of suspected fraudulent insurance claims. In many states, for example, it's an invasion of privacy to use a video camera in an unlawful or unreasonable manner. Zenith personnel can manage the investigation to produce the best result for the time and money invested. Also, Zenith personnel are trained to build and present a strong case to law enforcement and regulatory authorities. Finally, while insurance companies will normally qualify for civil immunity, you and your company may not have this important legal protection.

Zenith does not regularly advise an individual who submits a fraud report of an investigation's status. This is due in part to the fluid state of privacy legislation. Also, when we share such sensitive information, it raises the risk that word will reach the party under investigation. This can harm the investigation. In some states, the authorities are prohibited by law from sharing information about an investigation with the reporting party. In those states where a criminal conviction is public record, Zenith will advise the insured of the conviction.

Penalties can range from a fine, restitution and probation, to a misdemeanor conviction (less than one year in jail), to a first-degree felony conviction (up to 30 years in prison).