How to Spot Worker's Compensation Fraud
Worker’s compensation is a wonderful safeguard for injured workers, however, there are always a few who try to take advantage of the system by filing false claims. Moral issues aside, worker’s compensation fraud costs employers money and clogs up the system, slowing down the processing of legitimate claims. Worker’s compensation claims also increase a business’ monthly premiums on worker’s comp insurance, further adding to the burden fraudulent claims create.
If you are a business owner, you should know how to spot worker’s compensation fraud. Here are a few tips to help you recognize fraud when it happens.
Tips for Spotting Worker’s Compensation Fraud
Spotting worker’s compensation begins with the injured employee. If an employee is filing a fraudulent claim, they often:
- Are uncooperative, hostile, or slow in assisting you with filing a worker’s comp claim on their behalf
- Move to a new address soon after the alleged injury occurs
- Claim a more serious injury than what is observable
- Have previously been involved in worker’s comp claims
- Have recently been demoted, passed for a promotion, reprimanded, or has some other type of grievance with the company
- Has an unstable work history, frequently changing jobs with or without valid reasons for leaving
- May have large gaps in employment history that could indicate unfavorable employment history or time off due to a previous comp claim
The next step in spotting worker’s compensation fraud is investigating the injury. Fraudulent injuries often:
- Occur without any witnesses to corroborate how the injury occurred
- Occur on Fridays or Mondays if the employee is scheduled to work a weekend
- Send first notification of the claim via the allegedly injured employee’s attorney, not the employee
- Uncorroborated by a physician
- Involves mostly subject complaints, such as an employee’s report of pain, fatigue, or other medically immeasurable symptoms
- Is not reported immediately after the injury occurs
- Contains vague, inconsistent, or conflicting reports or symptoms
Often, the medical treatment that the allegedly injured employee receives provides clues to the fraudulent nature of the claim. These clues may include:
- Once the employee is released to go back to work by one physician, they seek a second opinion from another doctor and work restrictions are continued under the new physician
- The employee changes doctors often or sees multiple physicians (excluding specialists)
- The employee reports a level of wellness that is inconsistent with their overall behavior and activity level
- The employee’s injury report is inconsistent with the initial report from the examining physician
Some physicians have a reputation for leniency in worker’s compensation claims. Knowing who these doctors are in your area can help you spot a fraudulent claim faster.
Lastly, the worker’s compensation claim itself can help you spot fraudulent claims. Fraudulent worker’s comp claim may:
- Be handled by an attorney who is well-known for handling worker’s compensation cases
- Be represented by a lawyer who is excessively aggressive, demanding, and uncooperative
- Include an immediate demand for settlement
- Be filed by an employee who is overly knowledgeable of the worker’s compensation claim process and applicable worker’s compensation laws.
- Include reports from a physician who is known for participating in false worker’s comp claims
Spotting worker’s compensation fraud is not easy, but knowing the warning signs of a false claim can help protect you and your employees from the fallout of fraudulent claims. Contact your local worker’s compensation bureau to learn more about worker’s compensation fraud.