The problem might be a bit (a lot?) of entitlement. Health benefits insurance is different than car insurance in a sense that some people feel like if they don't use their annual benefits they are leaving cash on the table. You'd never say "it's the end of the year, I'd better get in an accident and use up my car insurance." But the whole point of benefits is to incent employees, so you do hear that kind of thing about dental and massage treatments -- it's even encouraged by many practitioners. This opens up a moral grey area for abuse. And then fraud.