As a business owner, the safety of your employees is a necessity. Fortunately, workers’ compensation is required for all businesses in most states in the US. Workers’ compensation provides lost wages, medical treatments and more to any employee that is injured at the job.
But what happens if someone in your staff takes advantage of this policy and files a fraudulent claim? According to Zywave, “while the majority of work comp claims are truthful, the National Insurance Crime Bureau reports that billions of dollars of false claims are submitted each year”.
If two or more of the following scenarios are present when an employee is filing a claim, there is more potential for it to be a fraudulent claim.
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Mondays: The supposed injury happens either first thing on Monday morning, or the previous week, but was not reported until Monday.
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Changes at Work: The supposed accident happens immediately before or after a significant change at the place of work.
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Job Termination: The employees files a work comp claim after being terminated.
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History of Frequent Changes: The employee has a history of making frequent changes (jobs, doctors, address, etc).
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Medical History: The supposed sustained injury is similar to a pre-existing condition the employee has.
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Lack of Witness(es): There was no one to witness the accident, and there are conflicting descriptions of the accident
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History of Claims: The employee has a previous history of numerous claims.
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Refusing Treatment: The employee refuses treatment to confirm the injury.
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Reporting it Late: The employee fails to report the claim in a timely manner, with no reasonable explanation.
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Difficulty Contacting: You, the employer, have a difficult time getting in touch with the employee while they are out.
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Moonlighting: Is the employee working more than one job? This can include volunteer work.
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Coincidence: The time of injury is correlated with the employees need or want for personal time.
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Financial Problems: The employee has known financial issues.
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Outside of Work Hobbies: The employee partakes in a hobby that can cause a similar injury as what they are filling the claim for.
It is important to note that if an employee files a workers comp claim and one of these scenarios is present, it does not mean that they are filing fraudulently. It is up to you, the employer, to use your best judgment regarding the situation.
If you would like more information on all things workers’ compensation, please fill out the form below. You can also call us at (303) 279-9700