How do you know that the worker who claims to have been injured on the job isn’t committing workers’ comp fraud?
Over the years, employers and insurance companies have uncovered some telltale signs.
Any one of these red flags alone probably isn’t enough reason to suspect fraud. There’s a better chance the worker may be trying to pull one over on you notice a few of these situations:
- The disgruntled employee. While a worker known as a regular complainer might seem to be the most likely candidate, also consider workers who were recently denied vacation time, demoted or disciplined, and are keeping quiet about it.
- Difficult to contact. Injured employees who are difficult to contact at home may be working at other jobs. Also, beware when employees aren’t available immediately but call right back. In the age of cell phones, people at home can call employees at their new jobs, and then the employees call back using their cell phones.
- The new employee. Statistics show the newer the employee, the more likely a claim is fraudulent.
- No witness. This is more likely to be a red flag when the employee normally doesn’t work alone.
- Unusual circumstance. This one is related to no witness. Was the employee supposedly working somewhere they wouldn’t be normally?
- Rough hands. Calluses or grease under fingernails may be a sign that the worker is double-dipping at another job.
- Knows about workers’ comp. Does the employee show an unusual knowledge about the workers’ comp system?
- 24-hour lawyer. Did the employee get a lawyer very soon after the injury occurred?
- Doctor shopping. A request for a second opinion may not be a red flag, but watch out when the need for a new physician happens after the first doctor says the employee can go back to work.
- Good timing (for the employee). This includes before a layoff and injuries that are reported early on a Monday — a sign that the injuries may have happened off-the-job, over the weekend.
Do you have any signs of fraud to add to this list? You can share your experience in the Comments Box below.