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7 Warning Signs Of Workers' Compensation Claim Fraud

September 22, 2015

States require employers to provide workers’ compensation insurance to cover an employee’s lost wages due to an injury on the job.

It’s a sad fact that to some unethical workers, workers’ compensation claims look like a ticket to getting paid for not working. Whether it’s exaggerating the extent of an injury or outright faking it, it’s illegal and costly to employers, insurers and society as a whole. It raises insurance costs for all businesses.

Check out this list of warning signs of workers’ compensation claim fraud. If you suspect fraud, it’s probably worth hiring a firm that conducts workers’ compensation claim investigations.

  1. Worker is hard to reach
    If a supposedly home-bound worker is difficult to reach at home on the phone and does not return messages promptly on a regular basis, it could indicate that their injury is not that serious. Or if the background noise on a cell phone call sounds like they are out, they may not be at home when they are supposed to be.
  2. Use of same doctor as other claimants
    Unfortunately there are some unethical service providers in the system, and often the word will get out. If a particular doctor seems to be servicing a lot of the claimants, something could be going on.
  3. Claim occurs on Monday morning
    If a worker has weekends off, and files a claim on Monday morning, the claim is suspect and more questions should be asked. The same is true if a worker says the injury occurred on a Friday afternoon but does not file the claim until Monday morning.
  4. Claim occurs prior to a significant change
    An employee files a claim prior to the end of seasonal work, near the end of a project, or before a layoff or a strike.
  5. Worker’s description of the injury does not coincide with medical findings
    If the description an employee gives of their injury does not match up with what the medical report says then their description is suspect.
  6. History of claims
    An employee has a history of filing workmans’ compensation claims, especially litigated claims.
  7. No witnesses
    There is no one to corroborate the employee’s version of what happened.

How Can You Be Sure A Workers' Compensation Claim Is Valid?

None of these warning signs in and of themselves can establish fraud. To be sure, Radius Investigations can perform workers’ compensation claim investigations if you think an employee is gaming the system. Our team of investigators will examine the findings and interview other employees, supervisors and medical providers to get all the facts. If necessary, video surveillance can be carried out.

Workers’ compensation claim investigations include the following: evidence to support or deny claims, assistance in reassessment of claims, detailed activities reports from qualified investigators, expert witness testimony and affidavits, video recording and photographs, full report explanation, and multiple report delivery formats.

If you think our workers’ compensation claim investigations would help your company combat fraud, please call Radius Investigations for a free consultation at 888-698-0077. The lines are open 24 hours a day.

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