Do you think a workers’ compensation claim is fraudulent?

On Behalf of | Oct 5, 2020 | Workers' Compensation Defense |

Your company wants to keep its staff safe because an injured worker is a non-productive worker. In addition to proper training and the right safety protocols, your company will also likely have a workers’ compensation policy that covers workers if they get hurt on the job. It’s an expensive kind of coverage, but it’s invaluable to the people who work for you.

The vast majority of people who need to claim such benefits only do so when they have a real need. Unfortunately, there may be a small minority of claimants to make a fraudulent claim hoping to get benefits that they don’t need or that they need but don’t qualify for.

Protecting your business from workers’ compensation fraud often requires that you carefully scrutinize every claim made by one of your staff members. What are some of the common forms of workers’ compensation fraud?

Workers claiming benefits for an outside injury is a risk

For workers who get hurt and don’t have disability insurance, they may worry about whether they will be able to pay their bills while they recover. They might try to stage an incident on the job to make it look like they got hurt while working so that they can have paid recovery leave and 100% medical coverage.

These claims may happen on a Monday morning or get filed on a Monday with a claim that the injury occurred on the previous Friday. Sometimes, workers make claims right when they start a new job or when they know they are about to get fired or laid off by management.

Workers seek treatment from questionable providers

Sometimes, workers don’t want to take a paid vacation with a fake injury. They may have a real injury and exaggerate its seriousness. When a worker insists on picking their own care provider, especially if it’s someone who has a questionable history or a direct relationship with the work, the scheme might be to bill for unnecessary treatment.

What are red flags to watch for?

Besides evidence that the injury existed before the worker made a report, there are other warning signs. Late reporting of accidents, refusing to follow medical recommendations, getting hurt when there are no witnesses or cameras nearby, or a history of lying or repeat claims are all signs that a claim may not be valid. If you suspect fraud, you have the right to defend your company against such fraudulent claims.