Georgia Workers’ Comp Fraud: New Risks for 2026

There’s a staggering amount of misinformation swirling around the topic of workers’ compensation, particularly concerning fraud. Many people in Roswell, and indeed across Georgia, hold deeply flawed beliefs about who commits workers’ comp fraud and what the actual consequences are, leading to significant legal risks for all involved.

Myth #1: Only injured workers commit workers’ comp fraud.

This is perhaps the most pervasive and damaging myth out there. When most people hear “workers’ comp fraud,” their minds immediately jump to an employee faking an injury or exaggerating symptoms to collect benefits. While claimant fraud does happen, it’s far from the only type, and frankly, it’s often not even the most financially impactful. I’ve seen firsthand how this narrow focus can blind people to other, equally serious forms of fraud. The reality is that employers and medical providers are just as capable, if not more so, of committing workers’ compensation fraud. Employer fraud can take many forms: misrepresenting payroll to reduce insurance premiums, failing to secure proper workers’ compensation insurance at all, or even pressuring injured employees not to report claims. For example, an employer might classify high-risk employees under a lower-risk job code to pay less in premiums. We represented a client a few years back, a small construction company near the Chattahoochee River, whose owner was systematically underreporting his payroll by almost 40% to his insurer. This wasn’t an accident; it was a deliberate scheme to save money, and it put his legitimately injured workers at immense risk. When one of his roofers fell and sustained a serious back injury, the insurance company’s audit quickly uncovered the discrepancy. That owner faced significant fines and potential criminal charges, not just for the fraud but also for operating without adequate coverage. Medical provider fraud is also a serious issue. This can involve billing for services not rendered, upcoding procedures (billing for a more expensive service than was performed), or even encouraging unnecessary treatments to inflate bills. According to the Coalition Against Insurance Fraud, medical provider fraud costs the insurance industry billions annually across all lines of insurance, including workers’ compensation. This isn’t small change. When a doctor or clinic on Canton Road bills for physical therapy sessions that never happened, or for equipment that was never provided, that’s fraud. It drives up costs for everyone and undermines the entire system.

Myth #2: Workers’ comp fraud is a victimless crime.

Absolutely not. This myth is dangerous because it trivializes the serious consequences of fraudulent actions. Some people think, “It’s just insurance money,” but that couldn’t be further from the truth. Workers’ comp fraud has tangible, detrimental effects on businesses, employees, and the overall economy. When an employee commits fraud, it directly impacts their employer. Premiums can skyrocket, leading to increased operating costs that might force a business to cut jobs, reduce wages, or even close its doors. Imagine a small business in the Roswell Historic District, perhaps a boutique or a restaurant, already operating on thin margins. A fraudulent claim can be the final straw. For legitimate injured workers, fraud can also slow down the claims process and make insurers more skeptical, creating additional hurdles for those who genuinely need assistance. This is a real concern; I’ve had clients whose legitimate claims were initially met with undue scrutiny simply because of a general atmosphere of skepticism fueled by widely publicized fraud cases. When employers commit fraud, it’s the employees who suffer. If an employer deliberately misclassifies workers or underreports payroll to save on premiums, there might not be sufficient funds available when a legitimate injury occurs. This leaves injured workers without the benefits they are legally entitled to, forcing them to bear medical costs and lost wages out of pocket. O.C.G.A. Section 34-9-121 clearly outlines the employer’s responsibility to provide workers’ compensation coverage. Failure to do so, especially intentionally, can lead to severe penalties, including fines of up to $50,000 and even imprisonment. And when medical providers engage in fraud, it inflates the cost of healthcare for everyone. These costs are passed on through higher insurance premiums, not just for workers’ comp but potentially for other health insurance plans too. It also diverts resources from legitimate patient care. In essence, workers’ comp fraud isn’t a victimless crime; it’s a crime against legitimate businesses, genuinely injured workers, and the integrity of the entire system.

Myth #3: It’s easy to get away with workers’ comp fraud.

This is a grave misconception that can lead to serious legal trouble. The idea that you can simply “pull one over” on the system is outdated and ignores the sophisticated tools and dedicated resources now employed to detect fraud. The Georgia State Board of Workers’ Compensation (SBWC) takes fraud very seriously and actively investigates suspicious claims. The SBWC has an Enforcement Division specifically tasked with investigating workers’ compensation fraud. They collaborate closely with other state agencies, law enforcement, and insurance carriers. These investigations often involve surveillance, forensic accounting, and detailed medical reviews. Insurance companies themselves employ sophisticated data analytics and fraud detection software to flag anomalies in claims. For instance, if a claimant reports an injury but is then seen performing strenuous activities, or if a medical provider consistently bills for unusual treatment patterns, these flags will trigger an investigation. I recall a case involving a client who thought he could continue working a second, physically demanding job under the table while collecting benefits for a reported back injury from his primary employer. He was convinced nobody would ever find out. However, an investigator for the insurance carrier used publicly available social media posts and old-fashioned surveillance to document his activities. The evidence was undeniable. Not only were his benefits terminated, but he also faced criminal charges under O.C.G.A. Section 34-9-19, which makes it a felony to make false statements or representations for the purpose of obtaining or defeating any benefit or payment. He ultimately received a felony conviction, probation, and had to pay restitution. This wasn’t some elaborate, high-tech sting; it was diligent investigative work. The system isn’t perfect, no system is, but it’s far from easy to manipulate without severe repercussions.

Myth #4: If I don’t report suspected fraud, it’s not my problem.

This couldn’t be more wrong. In Georgia, there are legal and ethical obligations to report suspected workers’ compensation fraud, and failing to do so can have negative consequences, including potential complicity. For employers, O.C.G.A. Section 34-9-19(b) explicitly states that any employer who has actual knowledge of a false or fraudulent claim and fails to report it to the SBWC or the appropriate law enforcement agency can be subject to administrative penalties. This means if you, as a business owner in Roswell, suspect an employee is faking an injury, or if you find out one of your managers is deliberately underreporting payroll, you have a duty to report it. Ignoring it doesn’t make it go away; it makes you potentially liable. For employees, while there isn’t a direct criminal penalty for not reporting someone else’s fraud, it undermines the system that is there to protect them. Furthermore, if you are aware of fraud being committed by your employer, and you benefit from it, you could be seen as an accomplice. Beyond legalities, maintaining a workplace culture where fraud is tolerated can foster an environment of distrust and unfairness. It affects morale and productivity. We always advise our clients, whether they are employers or employees, that if they have reasonable suspicion of fraud, they should report it to the SBWC’s Enforcement Division, whose contact information is readily available on the State Board of Workers’ Compensation website. Reporting fraud protects the integrity of the system for everyone.

Myth #5: All workers’ comp claims are fraudulent until proven otherwise.

This cynical view is not only incorrect but also deeply unfair to the vast majority of legitimate injured workers. While fraud exists, it represents a very small percentage of total workers’ compensation claims. The overwhelming majority of claims filed in Georgia are legitimate, representing real injuries sustained by real people in the course of their employment. Adopting a “guilty until proven innocent” mindset regarding workers’ comp claims creates an adversarial environment that actively harms legitimate claimants. It leads to unnecessary delays, increased legal battles, and a general distrust between employers and employees. Workers’ compensation was established to provide a safety net for workers who get injured on the job, ensuring they receive medical care and wage replacement benefits without having to prove fault. This system is crucial for protecting the financial stability of families in communities like Roswell when an unexpected workplace accident occurs. While vigilance against fraud is important, it should never overshadow the fundamental purpose of workers’ compensation: to care for legitimately injured workers. The focus should always be on fair and timely processing of claims, reserving fraud investigations for genuinely suspicious circumstances. My experience over the years has shown me that legitimate claims, processed efficiently, ultimately save everyone money by getting injured workers back to health and back to work sooner. It’s a system designed to help, and we should protect that intent. Workers’ compensation fraud carries serious legal risks, not just for the individual committing the fraud but for anyone who knowingly ignores it. Understanding the true nature of fraud and its consequences is paramount for businesses and employees in Roswell to navigate the workers’ compensation system effectively and ethically.