Know the warning signs of workers’ compensation fraud: A guide for uninsured and insured employers

There are many signs that exist that could indicate an employee is exaggerating or fabricating his or her injuries after a workplace accident.

When employees in California are involved in a work-related accident, some may try to exaggerate or even fabricate their injuries. When employees fraudulently receive workers' compensation benefits as a result, this can strain a company's operations and also lead to elevated insurance costs. If the fraud is discovered it can lead to criminal prosecution.

Signs of claimant fraud

There are several signs employers should watch out for if they suspect that one of their employees is trying to exaggerate injuries or falsely claim that he or she was injured in an accident. According to Business News Daily, these include some of the following:

  • Lack of witnesses - when an injured employee's description of an accident does not match a logical cause and no witnesses can attest to the accident, workers' compensation fraud may be occurring.
  • Refusal of treatment - an employee may be fabricating his or her injury if he or she refuses to undergo diagnostic testing to determine the severity of the injury.
  • The injury occurs after an employment transition - an employee may be more likely to falsely claim the need for workers' compensation benefits after being terminated or laid off or at the conclusion of a large project.
  • The injury is reported on a Monday - if an employee reports his or her injury early Monday morning or during the same time for an injury that occurred the previous Friday, a fraudulent situation may be happening.
  • The injured employee fails to communicate - an employee who is difficult to contact or slow to respond to messages after an accident may be dishonest about his or her need for workers' compensation benefits.

Social media evidence

Today, social media evidence can also indicate whether or not an employee has committed workers' compensation fraud. According to the American Bar Association, Federal Rule of Evidence 401 allows for this type of evidence as long as it is relevant to the situation and makes the situation more likely to have occurred than if the evidence did not exist.

There are a variety of different ways an injured worker can be identified for committing workers' compensation fraud using social media evidence. For example, if a warehouse worker hurt his back and is unable to work, but his Facebook page boasts that he went out bowling with his friends after the accident, he may be exaggerating the extent of his injury.

Seek legal representation

Employers in California who believe that one of their employees is fraudulently claiming workers' compensation benefits may be unsure of what steps to take next. If you are in a similar situation, contact an attorney to determine how to legally proceed.

Keywords: workers' compensation, employer, defense