EXCLUSIVE: Red Flags for Work Comp Fraud

By Rebecca Shafer

These are some common indicators that the claim may be fraudulent or the claimant may be exaggerating the extent of the injury:

An injury takes longer to heal than the medical guidelines specify;
An injury is reported late or is reported to a lawyer or the state commission before being reported to the employer;
When a claimant fails to attend weekly meetings;
When a claimant is uncooperative, for example, refuses to try a transitional duty job;
When a claimant is never home when you phone, especially during normal workday hours;
When a claimant has only a postal box, not a home address;
When the claimant misses doctors' appointments;
When the claimant is known to participate in seasonal activities, hobbies or work;
When the claimant has moved out of town or out of state;
When the word "disproportionate" is used in medical reports;
If the claim was reported after disciplinary action or just prior to layoff ;
When things just don't add up.

In situations where you believe the extent of the injury may be exaggerated or the claim may be fraudulent, such as if the claimant is working under the table, report it to your insurance company then follow-up to make sure they have taken action.

Follow up is critical. Always ask for “surveillance” not just “investigation” because in the later, they will only go door to door asking neighbors about the claimant’s activities. While that type of “activities check” may be warranted, it is important you know you are getting an activities check not surveillance.

For further information, visit www.ReduceYourWorkersComp.com

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