Despite a company’s best efforts to prevent workplace injuries, accidents can happen on the job. Especially in safety-critical environments like the industrial frontlines.
The way employers handle claims when injuries occur can help keep costs down. This includes being able to identify warning signs of workers’ comp fraud, which can lead to higher premiums for policyholders.
Employers can watch for the following red flags which might warn of a fraudulent claim:
1 – Late Reporting: An employee’s delay in reporting an injury claim can be a warning sign, whether they have no explanation for the late claim or they attest their injury progressed after some time passed. In this situation, witnesses to the incident may help to substantiate a late-reported claim.
2 – Improper Reporting: When an employee reports an injury to another party first, such as other employees, an attorney or a medical practitioner, employers should take notice. Some doctors and lawyers are known to be involved in false claims.
3 – Monday Morning Reporting: If an employee reports a claim on Monday morning for an injury that occurred on Friday afternoon this may alert employers to a non-work-related or weekend incident injury.
4 – No Witnesses: When there are no witnesses for a reported injury, or a witness’s version does not match the claimant’s description of the injury, this should be considered a red flag.
This is especially relevant if the employee typically works around others who would be likely to have seen an incident.
5 – Questionable Symptoms: While it may not mean anything is amiss, if an employee’s symptoms cannot be proven medically, such as with back pain, stress or headaches, it could be a warning sign. The employee could be trying to receive compensation for an injury that produces no medical evidence.
6 – Suspicious Timing: If an employee’s injury date lines up with previously-requested days off from work, employers should take heed. A denied vacation might motivate a disgruntled employee to file a false claim.
7 – Differing Descriptions: It’s a red flag when an employee’s description of an injury varies from or conflicts with the injury report, a medical practitioner’s findings or their medical history. Watch for inconsistencies in the date, time and location of the injury.
8 – Vague Details: An injured employee should be able to clearly and consistently describe the details of the incident. If they are vague, change their story often or details are otherwise questionable, this could be a warning sign.
While one or two of these conditions present doesn’t necessarily mean an injury claim may be fraudulent, it’s smart to be aware of what the potential warning signs are. If several of these indicators are present, employers should promptly investigate further to determine if a claim may be exaggerated or falsified.
Being alert to workers’ compensation red flags should be a key component of all companies’ claims review processes. Furthermore, clear policies on reporting incidents and injuries in a timely manner can help employees and employers avoid unnecessary confusion and costs.