Safeguards in place to deter fraudulent injury claims at workplace: MOM

The Ministry of Manpower (MOM) has safeguards in place to prevent fraudulent claims under the Work Injury Compensation Act (Wica).

At a media briefing on Friday (Aug 1), the ministry said that Wica is in place to balance the interest of employers and workers.

All employers are required to purchase Work Injury Compensation (WIC) insurance under MOM regulations, for all manual workers regardless of salary and non-manual workers less than or equal to $2,600 per month.

Under Wica, employees can make claims for medical leave wages, medical expenses and lump sum compensation in the case of permanent incapacity, current incapacity or death. 

On average, 28,500 WIC claims are made each year, of which around 26,800 are paid out, the ministry said.

It said that the median time taken to process a claim is about six months, with around 95 per cent of claims being resolved within one year after being filed.

3 safeguards in place to protect against fraud

MOM said that there are three safeguards in place, which separately come under the purview of insurers, doctors and the ministry.

Insurers are the first line of defence in detecting WIC fraud, who typically engage loss adjustors to investigate suspicious claims, which will be subsequently escalated to the ministry.

Doctors are the second line of defence, and refer to "prescribed and detailed guidelines for assessment of degree of permanent incapacity".

In any case of disputes on the degree of permanent incapacity awarded, the parties can object, and the case can be referred to the WIC Medical Board for independent reassessment.

Additionally, all parties are able to raise objections to WIC claims during the process, which will be referred to MOM for adjudication.

Of all claims made, MOM gets objections to less than 3 per cent.

On top of the three safeguards, the ministry has compensation caps in place to limit employer's financial liability.

Around 12 claims per year investigated for fraud

Both errant employers who fail to fulfill their Wica obligations and workers who make fraudulent claims will be prosecuted under MOM regulations.

WIC insurance is meant to "protect employers against sudden large payouts due to work injuries", and employers who fail to fulfill their Wica obligations will face fines of up to $15,000, jail terms of up to 12 months, or both.

Workers found making fraudulent claims may be fined up to $15,000 or jailed up to 12 months, or both.

According to MOM, insurers refer about 12 claims per year for investigation into potential WIC fraud, with around two workers being prosecuted per year after the relevant investigations.

Sumo Salad case still under investigation

MOM also provided an update regarding the recent case involving Jane Lee, the owner of Sumo Salad, who died on July 19 after making two Facebook posts alleging that an employee had faked an injury to claim workplace injury compensation from the company.

The ministry said the accident occurred on June 6, and that Sumo Salad had submitted a work injury incident report to it, adding that the firm was "covered by a valid insurance policy", and was fully reimbursed on June 26 and June 27 for the work injury incident reported.

According to MOM, the case is still under investigation and that the claims process has not been completed.

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dana.leong@asiaone.com