Workers comp fraud warning signs

  • Posted on: Aug 15 2022
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When an injury occurs in the workplace, the way it is handled may differ between employers. However, when the injury occurs due to a common cause such as a fall, slip, or trip, and repetitive stress, then there may be a potential for fraud.

In fact, fraud involving workers´ compensation is a crime that is always investigated. The type of fraud most common among workers´ compensation is known as claim-related fraud. This type of fraud occurs when a claim is falsely made in order to gain benefits through a false injury that takes place while working. When this fraud is committed, the premiums that the employer pays will become higher, which may cause problems for employers who are truly hurt.

Warning Signs Surrounding Workers´ Compensation Fraud

Although it may be difficult to identify true fraud involving workers´ compensation, a few warning signs exist that an employer needs to recognize.

Beginning of the week Injury

An injury takes place at the beginning or end of the work week on Monday or Friday. Usually, an injury occurring on Friday will be reported on the following Monday morning.

The Injury is Reported Late

An injury is reported several days after the fact with no explanation.

A Change in Employment

If the employee experienced a change in employment, such as being laid off or terminated, then you may see a fraudulent claim come up.

Witnesses are Nonexistent

The employee is unable to present witnesses to the injury and the description does not match up with what caused the injury.

Cannot Reach the Claimant

When trying to contact the claimant, they are difficult to reach.

Providers Seem Suspicious

The medical doctor the employee sees has a suspicious history relating to fraud claims.

General Changes

A claimant has made several changes in the past regarding job, address, or doctor.

Refusing Treatment

When a claimant refuses treatment or a procedure to confirm an injury, then it will likely be fraud involved.

Descriptions are Conflicting

When the report of the injury is different from the employee´s description, then there may be fraud involved.

A Claims History

Several claims have been submitted by the employee that seem suspicious.

Past history has shown that if more than one warning sign exists within a workers´ compensation claim, then fraud may be attempted. It is important to remember that these warnings do not mean true fraud is being committed, they are only indications to be aware of.

If fraud is suspected, then it should be reported to the insurance carrier. That way the claim can be investigated by the authorities. Make sure that there is a sufficient amount of evidence that can back the investigation such as witnesses and being able to recognize when misstatements are made.

Conclusion

Having fraud occur within the workplace can become a nightmare for the employer. It can also impact the way legitimate injuries get handled, which can cause delays. This is why you should get a hold of our office today when you suspect workers’ compensation fraud. We´ll get the fraud investigated and the problem resolved so that you can get back to business as normal.

Posted in: Blog, Workers Compensation Benefits

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