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Common signs of workers' compensation fraud

In representing employers who have workers’ compensation claims lodged against them, we have gained a wealth of experience in rooting out fraudulent claims. Indeed, false claims do not outpace legitimate claims, but because of the proliferation of bogus claims, insurance costs are bound to increase for employers and through throughout the industry.

Because of this, it is helpful to remind our clients from time to time about the signs that could signify a false workers’ compensation claim. This post will highlight a few common flags.

Injuries reported just after an employment change – Employers should be wary of claims that are raised immediately after a job termination or layoff, or at the end of a contract term.

Injuries late in the week – Injuries that ostensibly occur late on a Friday afternoon, but are not reported until Monday of the next week can be suspicious.

No witnesses to the accident – When no one sees the accident, or the injury after the accident occurs, the claim could turn out to be falsified.

The account does not make sense – When the description of the accident does not logically support how the accident could have occurred, or the employee’s own description conflicts with the initial report, the claim could be false.

Refusal of treatment – If the worker refuses to participate in diagnostic procedures to confirm the stated injury, chances are that the claimed injury has not occurred.

History of false claims – Employers should be wary of employees who have a history of suspicious workers’ comp claims, or a history of litigation.

Source: “InFocus: Top 10 red flags of workers’ compensation fraud,” Caitlin Bronson, Mar. 26, 2014

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