4 Ways To Identify Fraudulent Worker’s Compensation Claims
Dan Levenson August 09, 2016
Providing worker’s compensation coverage to your staff is an important part of keeping your business running smoothly and without the threat of expensive lawsuits if something happens to one of your workers on the job.
Unfortunately, some workers view worker’s compensation as a free meal ticket, an opportunity to leave work behind while continuing to draw a portion of their salary.
When you know how to identify worker’s compensation fraud, you can keep your business running without the fear that at some point, a worker is going to get injured and take you to the cleaners, so to speak.
Starting with these key signs can give you a fairly good idea of whether a worker’s compensation claim is real or fraudulent.
1. The Timing Of The Claim
Sometimes the timing of a worker’s comp claim is simply too coincidental to be true.
If it seems as though your employee is taking advantage of the system, going from clocking in bright and early every morning to filing a claim immediately following their termination, you need to take a more serious look at the claim to determine whether or not it’s a true need on the part of the worker.
2. The Employee’s History
There are some employees who are simply more prone than others to accident and injury. There are other times when it’s obvious that there’s something more going on.
If one employee repeatedly files worker’s comp claims or has a history of firing those claims with previous places of employment, it should immediately raise a red flag that lets you know that something isn’t quite right.
Your company’s lawyers might also want to take a look at the employee’s medical history to make sure that they aren’t taking an old injury or disability and turning it into a more recent claim.
3. Something Doesn’t Add Up
Was your worker injured when there was no one else around to see it? What about the story they’re telling—is it the same every time, or are there little inconsistencies as the employee finds ways to make the story better?
There are a number of tell-tale signs that someone is lying, and if you’re seeing plenty of them regarding the worker’s story, you might need to examine their claim more intently. Any time you feel as though something doesn’t add up with a claim, from conflicting stories from witnesses to an employee who is constantly changing their story, you need to examine the claim more intently.
4. The Worker is Uncooperative
Typically, the goal of a worker who is filing a genuine worker’s comp claim is to get back in the workplace as soon as possible. They want their injury to be healed, so they’ll do their best to get to doctor appointments on time and do whatever their physicians and therapists ask of them. They’ll be accessible to your staff, returning phone calls and emails quickly and efficiently. When they’re asked about accommodations that would make it possible for them to return to work, they’re eager to make those adaptations so they can get back to their regular schedule.
A worker who is uncooperative, difficult to contact, and unwilling to make necessary changes in order to return to work may be filing a fraudulent claim and should be watched carefully.
While workers should always be compensated when they’re injured on the job, keeping up with potentially fraudulent claims and ensuring that those individuals are dealt with accordingly is an important part of keeping your business running smoothly. When you know how to spot potentially fraudulent worker’s compensation claims, you can avoid a messy dispute and ensure that other workers won’t make the same attempt in the future.