How to Spot Worker's Compensation Claim Fraud:

While the majority of your employees are honest, hardworking people, you may be faced with worker's compensation fraud. As an employer, it is essential to be on the lookout for abuse of your worker's compensation insurance. This can assist you in keeping your premiums lower by avoiding false claims.

There are specific signs that you will need to watch for when looking for fraud with worker's compensation insurance. We will divide these warning signs into specific groups to assist you in keeping watch.

Employee Warning Signs

1. The employee is uncooperative in assisting you with their claim.
2. The employee moves away after the injury occurs.
3. The employee was terminated, demoted or has a grievance issue with you.
4. The employee has an unstable work history or a number of previous past claims.
5. The employee's injury is significantly less than they are claiming.

Injury Warning Signs

1. No witnesses were present when the injury occurred.
2. You receive notice of the injury from the employee's lawyer, not them.
3. The injury occurs either on a Friday before leaving or first thing on Monday morning.
4. The physician is unable to corroborate the injury with the employee's claim.
5. The employee does not immediately report the injury.
6. The reported injury is subjective, such as nebulous "pain."
7. The employee's report of the injury is vague and/or inconsistent.

Medical Treatment Warning Signs

1. The injured employee frequently changes physicians.
2. Once a release for work is issued, the employee goes to a new physician.
3. Reports of employee's wellness are inconsistent with their behavior.
4. The initial injury report does not coincide with the physician's report.

Claim Warning Signs

1. The employee's attorney has a history of handling false claims.
2. The employee is extremely familiar with the worker's comp process.
3. The attorney for the employee is overly pushy, demanding immediate settlement.
4. The employee's physician has a history of handling false claims.

You may never experience a false worker's compensation claim, but it is very important that you are aware of these warning signs. Insurance fraud is a booming business and even regular people can be tempted to take advantage of a situation. It is a good idea to let your employees know that you are committed to avoiding insurance fraud to discourage anyone from taking advantage of your insurance policy.

It is also important to look at the entire claim as a whole, to assist you in judging if fraud is really taking place. Don't jump to conclusions if only one point is met, or if something just doesn't feel right. You will need to be fair in your assessment of fraud to ensure that you are not wrongfully accusing an employee.

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