Ten Warning Signs That Might Indicate Workers' Compensation Fraud

Aggressively managing WC claims and being aware of potential claim fraud is very helpful in controlling costs. The following tell-tale signs by themselves may not cause you to suspect fraud, but usually there are more than one telltale sign in fraud cases. If you do suspect fraud, contact SABAL to find out how to handle fraudulent workers compensation claims. Watch for:

1. Lack of prompt reporting: In general, injured employees will report a claim on a timely basis. Late reporting in and of itself is not necessarily a cause for alarm, but it ought to be a signal to review the claim a little more closely than timely reported claims.

2. Sketchy details: Most claimants can recall the details of their injury. If the claimant seems to be fuzzy on the details and gives vague responses to questions, another reason to keep a close eye on the progression of the claim.

3. No Witness: Not every claim has a witness and should not be used solely to determine fraud; however, if many of the other signs are present, it will be hard to dismiss the lack of a witness.

4. Discrepancy in story: Upon further investigation, the claimant keeps changing the story and adding, removing pertinent information, a good reason to suspect it to be a fraudulent workers compensation claim.

5. First day of the week claims (Monday): If the injury allegedly occurred on Friday, usually late in the day, but did not get reported until Monday, there is reason to suspect there might be a little more going on than meets the eye.

6. Disgruntled employee: A disgruntled employee is more likely to place fraudulent claims than an employee with high job satisfaction.

7. Financial hardship at home: Workers compensation benefits are sometimes seen as a way out of a tight financial situation at home.

8. Employee never answers the phone (not home) and will call back in just a minute: If this happens once or twice, it may just be coincidental, but if it occurs every time the claimant is called, there is a possibility of fraud.

9. Misses medical appointments: If an employee is truly injured, they want to get better and will make sure to attend all necessary medical appointments. Missing appointments is another reason to suspect fraud.

10. Employee is engaged in activity that is not consistent with the injury sustained: If your employee reported a back injury and several other employees find that he is at home building a deck, there is a good reason to suspect fraud.