Employer in Sumo Salad case was fully reimbursed by insurer, which did not flag if fraud was involved: MOM

SINGAPORE: The employer in the Sumo Salad work injury case was fully reimbursed by the insurer on Jun 26 and 27 for medical bills and medical leave wage claims submitted up to that point, the Ministry of Manpower (MOM) said on Friday (Aug 1).

MOM also has not received any indication of fraud from the insurer to date and has not observed any evidence that a syndicate was involved in the case. 

The ministry provided this update during a media briefing on the Work Injury Compensation Act (WICA), following intense public interest in the case. It added that it was unable to provide the name of the insurer due to ongoing investigations.

The issue arose following the death of the owner of eatery Sumo Salad, Ms Jane Lee, who had published Facebook posts about a foreign employee who she claimed filed a false work injury claim to get compensation.

In a Facebook post on Jul 18, a day before she died, Ms Lee said that "because of an unfortunate gap in our insurance coverage, we are now being targeted by what I believe to be a fraudulent scheme".

The work injury claim was filed against EatGreen, the operator of Sumo Salad.

The ministry previously said that the worker involved was covered under the WICA, and that it was working with the employee's insurer to "assess the validity of the case".

On Friday, MOM said the work injury incident took place on Jun 6 and the employer subsequently submitted a work injury report to the ministry. It said the employer was covered by a valid insurance policy.

Apart from the MOM probe, the Singapore Police Force is also investigating Ms Lee's unnatural death.

"We have not received any indication from the insurer that there is fraud. But that is different from saying that there is no fraud, because we are investigating," said the ministry spokesperson.

The spokesperson added that the claims process in the Sumo Salad case has not concluded.

Asked about the status of the worker involved, the spokesperson said MOM does not typically comment on the employment status of particular individuals. The ministry may issue special passes for workers involved in some investigation cases to legalise their stay in Singapore.

AROUND 12 CLAIMS REFERRED YEARLY FOR SUSPECTED FRAUD

MOM said about 28,500 work injury claims are filed each year, and compensation is paid out for around 26,800 claims a year.

Insurers refer about 12 claims a year for MOM to investigate potential work injury compensation fraud.

The ministry said WICA imposes caps on compensation to limit employers' financial liability and protects employers against sudden large payouts due to work injuries.

At the same time, it gives workers social protections by providing a low-cost and expeditious route for work injury compensation.

Employers must buy work injury insurance for all manual workers regardless of salary, and non-manual workers earning S$2,600 or less a month. Platform operators must also have insurance coverage for all platform workers.

WICA covers medical expenses, medical leave wages and a lump sum compensation for permanent incapacity and death.

Over the past three years, 94 per cent of WICA claims were paid out by insurers. Most of the remaining 6 per cent of claims were directly paid out by employers that are exempted from buying work injury insurance.

MOM said that multiple levels of safeguards against fraud are in place. Work injury claims are assessed by insurers, who act as "gate-keepers"; and doctors, whose assessments of a worker's incapacity are "tightly prescribed".

All parties also have the opportunity to raise objections to a work injury claim. MOM said it receives objections to less than 3 per cent of all WICA claims.

INSURERS LOOK FOR ANOMALIES TO DETECT FRAUD

Responding to CNA's queries, Income Insurance's general manager of corporate business Susan Ong said that work injury compensation fraud "rarely occurs".

When a claim comes in, Income first assesses it based on "prima facie evidence" before considering several factors to decide if it should be investigated further.

"For example, we look for anomalies such as an employee bypassing the employer and filing the accident report directly with MOM without the employer's knowledge," said Ms Ong.

A significant delay in reporting the accident, such as months after the date of the alleged injury, can also warrant further investigation.

Another example is when the injuries that are reported seem inconsistent with the accident described, such as a case of a minor slip that somehow led to injuries to multiple parts of the body.

Ms Ong said if a formal investigation is triggered, independent loss adjustors are appointed. They interview the employer, injured worker and any witnesses, review documents and gather more facts.

Income will also obtain a medical opinion from the doctor who treated the worker, and may get an independent medical expert to validate the nature and extent of injuries.

The Migrant Workers' Centre (MWC) said it handled 602 work injury and medical assistance cases last year, up from 418 cases in 2023.

Despite the increase, MWC said it has not encountered any fraudulent claims in the cases it has supported.

"What we do observe are cases where workers are denied timely or adequate medical care, or are prematurely discharged by employers with the intent of repatriation," said the group.

MWC, an initiative of the National Trades Union Congress and Singapore National Employers Federation, said it works with the employers and authorities to support the workers in these cases.

It advised workers to lodge their work injury claims through the WICA system "rather than turning to alternative, unverified channels".

SME ASSOCIATION CALLS FOR MORE EDUCATION, SUPPORT

In a separate statement following MOM's briefing, the Association of Small and Medium Enterprises (ASME) said a work injury that is not genuine has an impact that goes "far beyond the financial cost".

"It inflicts significant psychological distress on owners who must continue running their business while managing the dispute," ASME said in a statement.

"While ASME does not track specific data on such cases, we are attuned to the deeper structural vulnerabilities that make SMEs more exposed."

Based on feedback ASME receives, many SMEs face a steep learning curve in compliance and human resource (HR) practices.

This association said it saw this as a challenge that stems from a critical gap in foundational business knowledge.

As a result, SME owners are "forced to learn reactively, often only after a major incident occurs", it said.

One way to address this is preventive education. ASME said it advocates for a structured "Business 101" onboarding programme for new entrepreneurs that integrates HR best practices and HR technology. It has a dedicated committee looking into this.

ASME said it is also exploring how to enhance the support it provides when incidents occur, as it sees a need for "a trusted, central point of guidance". It is looking at ways to strengthen the advisory role of its SME Centre.

To uphold the integrity of existing policies that are "pro-ecosystem", the association said there is a need to ensure such measures "are not misused by either employers or employees so as to protect the trust and fairness these policies are built on".

Helping entrepreneurs build strong foundations will not only protect them from disputes but prepare them for scaling up, it added.

Editor's note: An earlier version of this article incorrectly stated that the Manpower Ministry receives objections to less than 30 per cent of all WICA claims. The correct figure should be less than 3 per cent. We apologise for the error.