While most claims are truthful, fraudulent workers’ compensation claims can be very costly. In order to detect workers’ compensation fraud, it is helpful to learn the signs.
Statistics show that a claim may be false if you see two or more of the following:
Monday Morning: If the supposed “injury” takes place first thing Monday morning or late Friday but isn’t reported until Monday.
Changing Employment: When an accident is reported right before or after a layoff, a strike, at the end of a season of work, or immediately following a big project.
Post-Termination Claim: If an employee files a claim after being fired:
- Was the actual injury reported before the firing?
- Did the employee exhaust his or her unemployment benefits before trying to claim workers’ compensation benefits?
Pattern of Change: If the claimant demonstrates a pattern of constantly changing employers, addresses, or physicians.
Medical History: If the employee has a pre-existing condition that is suspiciously similar to the alleged injury sustained at work.
Zero Witnesses: There were no witnesses present at the time of the accident and the employee’s account does not seem to support a believable cause of injury.
Conflicting Accounts: If the employee’s account of the accident does not match up with the first report of the injury or the employee’s medical history.
History of Claims: When the employee has a history of numerous claims or suspicious litigation.
Refused Treatment: The claimant has refused to cooperate with diagnostic procedures to medically confirm or assess the extent of the injury.
Late Reporting: There was a significant delay in the reporting of the employee’s claim and there is no plausible explanation.
Difficult to Reach: If the claimant is supposedly disabled and you can’t seem to contact the individual at home.
Moonlighting: Is the employee working at another paying job or doing volunteer work?
Strange Coincidence: If the employee’s accident seems to suspiciously line up with his or her request for personal time off.
Financial Struggles: When the employee has been seen trying to borrow money from co-workers or has repeatedly requested pay advances.
Hobbies: The claimant has a known hobby that seems to be a capable of causing a similar injury to the injury allegedly sustained on the job.
ERM Insurance Brokers in Irvine, CA offers comprehensive workers’ compensation packages at the most competitive rates! Call now to speak with an ERM team member! (949) 222-0444