Workers’ compensation insurance is designed to provide financial protection to employees who suffer work-related injuries or illnesses. However, there are instances when individuals may attempt to take advantage of the system by submitting fraudulent workers’ compensation claims. As a business owner or employer, it is crucial to be aware of the red flags for workers’ compensation fraud and be able to identify potential warning signs. In this article, we will explore some key indicators of workers’ compensation fraud and provide insights to help businesses mitigate the risks.
Red Flags for Workers’ Compensation Fraud
Suspicious Injuries:
– Claims involving injuries that seem unusual or inconsistent with the nature of the job.
– Vague descriptions of the injury or lack of medical evidence to support the claim.
Inconsistent Statements:
– Statements made by the injured employee that change or conflict with the accounts of witnesses or medical professionals.
– Contradictions between the reported incident and the employee’s version of events.
Lack of Witnesses:
– Absence of witnesses to support the employee’s claim, especially if the incident occurred during regular working hours.
– Unavailability of colleagues who could verify the occurrence of the reported injury.
Delayed Reporting:
– Late reporting of work-related injuries without a valid explanation (e.g., reporting a Friday injury on Monday).
– Claims that include unrelated non-work injuries along with work-related injuries.
Excessive Claims:
– Claims that involve unusually high medical expenses or frequent medical visits without apparent improvement.
– Lengthy treatment durations that appear disproportionate to the severity of the reported injury.
History of Claims:
– Employees with a history of frequent or suspicious workers’ compensation claims.
– Multiple claims, especially with different employers, indicating a pattern of fraudulent behavior.
Prior Knowledge of Investigation:
– Employees who become aware of an upcoming investigation or surveillance and suddenly withdraw their claim.
– Abrupt changes in behavior or claim withdrawal after learning about the investigation.
Help Reduce Workers’ Compensation Fraud
Identifying red flags for workers’ compensation fraud is essential for businesses to protect their financial resources and maintain the integrity of the insurance system. By staying vigilant and recognizing warning signs such as suspicious injuries, inconsistent statements, lack of witnesses, and excessive claims, business owners can contribute to a better, safer workplace, and keep risk mitigation to a minimum.
Discover how employEZ can assist your business with workers’ compensation, including access to workers’ compensation insurance at rates that leverage the purchasing power of a Professional Employer Organization (PEO) and pay-as-you-go premiums from A-rated carriers. We’re here to help with a full suite of human resources related services and solutions. Learn more and contact us today.
