Warning Signs of Workers’ Compensation Fraud

Posted October 13, 2014 by Layne Davlin
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How can you spot Workers’ Compensation fraud?

Workers’ compensation fraud affects roughly 30 percent of all claims. While it’s important to watch out for this problem, you want to give appropriate support to employees who are legitimately hurt on the job. It can be difficult to balance your responsibilities with suspicions that you are being taken advantage of. Go after the wrong person, and you could get sued, not to mention tarnishing your reputation as a professional and community member.

It’s imperative you follow the law when responding to workers’ comp claims, but also keep your eyes open for the following red flags:

Claims Made on Monday Morning

One of the most common fraud flags, early Monday claim filing fraud, is also one of the most difficult to prove. Claimants typically have real injuries; they just didn’t happen at work. Put an emphasis on reporting injuries right away to prevent people who are hurt on Friday from waiting until Monday before they say anything. You want to take care of your best workers and, unfortunately, waiting before filing may create problems for their workers’ comp claim.

Claims Made by Problem Employees

People who cause problems on the job are often the same people who file false reports. Why? They’re angry for being called out on their bad behavior and think they’re owed some recompense. There are legal remedies for people who are mistreated at the workplace. These phonies file because they know they’d lose those battles. Worse, they’re adept at convincing others to follow in their footsteps. Protect yourself and your business by nipping these problems in the bud. Don’t hesitate to let your coverage provider know when a chronic dissenter might be a fraud.

Injuries Surfacing at the End of Big Projects

No one wants to think they’re being ripped off by their workers. We want to assume they’re filing because they’re injured, because we’ve worked them too hard and because they’re afraid of losing everything because they can’t perform. Unfortunately, more people file at the end of big projects because they’re tired rather than hurt. It isn’t your responsibility to pick up someone’s personal slack, so don’t feel guilty when end-of-project filings receive extra attention from the insurance company.

Injuries That Just Don’t Make Sense

Claims that don’t make sense are one of the most common signs of fraud, but they’re not always easy to spot. People often do reckless things on the job and wind up injured. These are considered valid claims unless they were done specifically to suffer an injury and file for workers’ compensation.

The difference between fraudulent and honest claims of this nature can typically be found in the extent of the risk endured. A worker won’t purposefully fall 30 feet onto concrete, for instance, because the risks of suffering serious injury are too great. However, an office worker who slams her hand in a drawer or a cook who touches the inside of an oven may have been looking for an easy way to get a few days of pay without working for them.

You have an obligation to provide workers’ compensation to your employees, but you also have the right to follow up on claims you think are false. Follow the legal guidelines for taking claims, encourage your workers to inform management of problems right away, but also talk to your insurance provider if you see these red flags.

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