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5 signs a workers’ compensation claim may be fraudulent

Most employers want to believe that their employees are trustworthy. If they weren’t, you wouldn’t have hired them in the first place, right? However, when it comes to serious claims against your business in the form of workers’ compensation, you want to be sure that both your employee and your business receive the protection they need. While most claims are legitimate, keeping a clear head when evaluating an injury report will help you to detect the few that aren’t. Here are some signs to watch for that could indicate you’re dealing with fraud.

1. No Witnesses

The simplest way to commit workers’ compensation fraud is to fabricate an unwitnessed event. If no one saw it happen, no one can contradict you. However, no one can verify it either. Most fraudulent claims share this characteristic. If that’s the story you’re hearing, be alert.

2. Social Media Inconsistency

The line between work life and personal life has blurred significantly with the rise of social media, and many employees share content with other employees or even their employers while they’re off the clock. You can use this to your advantage when trying to understand the truth of a workers’ compensation claim. If an employee is out for months with a disabling knee injury, but then posts pictures of themselves waterskiing, you don’t have to be Sherlock Holmes to figure out what’s going on.

3. Refusing Diagnosis

People committing fraud often want treatment, not diagnosis. If they have nothing to hide, they shouldn’t object to a treatment plan that also includes verification of the cause of the injury. If they do object—vigorously—it could be a sign that there’s more to the story.

4. Vague, Non-Specific Report

One thing you don’t want to do when listening to an employee’s injury story is to signal that you don’t believe them. However, you can ask follow-up questions while still being respectful. Think of the many details surrounding your business. What corroborating things might a person have noticed when the injury occurred? Try to get as full a picture as you can. If the details don’t hang together, or if the entire incident is so vague that it’s difficult to understand what happened, you could have a fraudulent case on your hands. Your instincts are valuable. Trust them.

5. Timing Of The Report

Was the injury report made long after the incident—a week or more? Was it reported first thing on Monday morning, when it could have happened over the weekend? These are common strategies when falsifying a workers’ compensation claim. They don’t prove fraudulence, but they could point to it.

While considering these factors, keep in mind that most workers’ compensation claims are legitimate—there could be a reasonable explanation why an honest claim appears fraudulent. You should always display compassion and understanding when responding to an employee’s claim of injury. However, you can be compassionate while also being rational, which will ensure that everyone involved—your employee and your business—has the greatest protection possible.

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