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Signs of Workers' Compensation Fraud

October 22, 2019

15 warning signs of workers' compensation fraud - Bay Area Insurance

Workers' compensation is a no-fault method of paying workers for medical expenses and wage losses due to on-the-job injury.

Most workers' compensation claims are truthful, but according to the National Insurance Crime Bureau, billions of dollars of false claims are submitted every year. Here are 15 signs to help you identify possible workers' compensation fraud:

If two or more of these factors are present, the claim may be fraudulent.

wWork claim injury form

  1. Monday Morning: alleged injury occurs either 'first thing Monday morning' or late Friday afternoon but not reported until Monday.
  2. Employment Change: reported incident occurs immediately before or after a strike, layoff, end of a big project, or at the conclusion of seasonal work.
  3. Job Termination: should an employee submit a post-termination claim, ask yourself:
    • Was the alleged injury reported prior to the employees' termination?
    • Did the employee exhaust his/her unemployment benefits prior to claiming workers' compensation benefits?
  4. History of Changes: the claimant has a history of frequently changing physicians, addresses, and places of employment.
  5. Medical History: employee has a pre-existing medical condition similar to the alleged work injury.
  6. No Witnesses: accident has no witnesses, and the employee's own description does not logically support the cause of injury.
  7. Conflicting Descriptions: employee's description of the accident conflicts with the medical history or first report of injury.
  8. History of Claims: claimant has a history of numerous suspensions or litigated claims.
  9. Treatment is Refused: claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
  10. Late Reporting: employee delays reporting the claim without a reasonable explanation.
  11. Hard to Reach: you have difficulty contacting a claimant at home, where he/she is allegedly disabled.
  12. Moonlighting: does the employee have another paying job or do volunteer work?
  13. Unusual Coincidence: there is an unusual coincidence between the employee's alleged date of injury and his/her need for personal time off.
  14. Financial Problems: employee has tried to borrow money from co-workers or the company, or requested pay advances.
  15. Hobbies: employee has a hobby that could cause an injury similar to the alleged work injury.

One Last Thing

If you have employees, you need workers' compensation coverage. Give Bay Area Insurance a call at 410-647-7333 or contact us online to get started today.