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Signs of work comp fraud that employers should be aware of

In our last post, we highlighted new potential legislation that would give the Division of Workers’ Compensation more resources to detect and prevent fraudulent claims. Yes, false claims do not outnumber legitimate claims, but fraud still causes problems for employers and insurers alike.

Because of the number of fraud claims we deal with, we find it helpful to remind our clients periodically of the signs of a false workers’ compensation claim. This post will highlight a few common red flags.

Injuries at the end of the week – Injuries that supposedly occur late on a Friday afternoon, but are not reported until Monday of the next week (so that the worker can take more time off) can be suspicious.

Accidents reported that have no witnesses – Let’s face it; it is easier to falsify a workers’ comp claim when no witnesses see the accident or care for the injured worker after it occurs.

Refusal of treatment – In the same vein, a worker who refuses to participate in diagnostic procedures to confirm the stated injury is likely falsifying the claim.

The account does not make sense – When the accident’s description does not support how it could have occurred, the claim could be false.

Injuries reported just after an employment change – Employers should be wary of claims that are raised immediately after a worker is terminated or at the end of a contract that is not being renewed.

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

If you have additional questions about challenging workers’ comp claims, we invite you to contact us.


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