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Inside Fraud Prevention:

Experience shows that when two or more of these factors are present in a workers’ compensation claim, there is a chance the claim may be fraudulent. Remember, though, that these are simply indicators. Many perfectly legitimate claims are filed on Mondays – and some accidents have no witnesses.

  • Monday Morning Reports: The alleged injury occurs first thing on Monday morning, or the injury occurs late on Friday afternoon but is not reported until Monday. 

  • Suspicious Providers: An employee’s medical providers or legal consultants have a history of handling suspicious claims, or the same doctors and lawyers are used by groups of claimants.

  • Conflicting Descriptions: The employee’s description of the accident conflicts with the medical history or first report of injury.

  • Treatment is Refused: The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.

  • Claimant is Hard to Reach: The allegedly disabled claimant is hard to reach at home.

  • Employment Change: The reported accident occurred immediately before or after a strike, job termination, layoff, end of a big project or at the conclusion of seasonal work.

  • No Witnesses: There are no witnesses to the accident and the employee’s own description does not logically support the cause of injury.

  • History of Claims: The claimant has a history of a number of suspicious or litigated claims.

  • Late Reporting: The employee delays reporting the claim without a reasonable explanation.

  • Changes: The claimant has a history of frequently changing physicians, changing addresses and numerous past employment changes.