When it comes to workers’ compensation, there are several different ways an employee could be committing fraud. The California Department of Insurance states that some of the most common examples include lying about the ability to work, the extent of the injury or the place where the injury occurred. Medical professionals can also join an employee in fraudulent activities by billing for service that was not provided or giving more treatment than is necessary. There are several red flags that employers can watch for to indicate that dishonest activity may be occurring.
First of all, the circumstances surrounding the injury can signal fraud. The Leavitt Group states that if an employee can produce no witnesses, it may be because the accident did not occur in the workplace. If the time of the accident is reported as being at the beginning or end of the work week, such as early Monday morning or late on Friday, it could be a sign that the injury was actually incurred outside of work hours. An unexplained delay in the reporting of the injury can also raise suspicion.
Next, if an employee will not allow doctors to evaluate the injury through diagnostic procedures, is vague about the symptoms or changes the story, it may be a sign of fraud. The actions of the employee after the accident can also be indicative of an issue. If the injured employee refuses to return to work to perform lighter duties or is difficult to reach when he or she is supposed to be home, an employer may suspect lying.
There are certain time periods that are more likely to produce fraudulent injury claims. If a big project or seasonal work has ended or the employee is scheduled for termination, a workers compensation insurance claim may be filed to avoid a loss of income. These red flags can be an indication to the employer that the claim needs further investigation to be proven legitimate.