10 Red Flags on Workers’ Compensation Claims
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.
Want to take this information with you? We offer an in-depth overview of the fraud warning signs and support programs provided by EMPLOYERS, as well as a quick-read Top 10 flyer that’s handy for both EMPLOYERS agents and policyholders.