Did they really get hurt at work? This is the question employers find themselves asking when presented with a suspicious workers’ compensation claim. According to the National Insurance Crime bureau, workers’ compensation fraud accounts for approximately 25% of insurance fraud at a cost of $7.2 billion annually. It is one of the fastest growing areas of fraud, increasing by 24% from 2013 to 2014.
If you believe a worker’s compensation claim may be fraudulent, there are several questions you should use to evaluate the claim:
Workers’ Compensation Red Flags
- Reports filed on Monday morning – Did the injury occur first thing Monday morning? Or late Friday afternoon, but was not reported until Monday?
- Change of employment – Did the reported incident occur immediately before or after a job termination, layoff, strike, or at the conclusion of seasonal work?
- A history of workers compensation claims – Does the employee have a history of suspicious or litigated claims?
- Conflicting stories and descriptions – Does the employee’s description of the accident match the medical history and logically explain how the injury was sustained? Does their story remain consistent with the first report of injury?
- Suspicious providers – Do the employee’s medical providers or legal consultants have a history of handling suspicious claims?
- Lack of witnesses – Were there any witnesses to the accident? Is there any surveillance footage?
- They refuse treatment – Does the employee refuse to undergo diagnostic procedures to verify the nature and/or extent of their injury?
- Frequent changes – Does the claimant have a history of regularly changing addresses, physicians, and employment?
- Unable to reach the claimant – Is the allegedly disabled employee hard to reach at home?
- Delayed reporting – Was the employee late in reporting their claim offering no reasonable explanation for the delay?
If two or more of these red flags appear in a workers’ compensation claim, there is a chance the claim may be fraudulent. Keep in mind that these factors do not necessarily mean fraud: some accidents have no witnesses and employees can get injured on Monday mornings.
If you suspect workers’ compensation fraud on the Main Line, call Know It All today. Our experienced investigators will conduct interviews with all parties involved and provide you with the facts you need to determine whether or not a claim has merit.
Know It All: Expert Private Investigators on the Main Line
Since 1999, Know It All has been conducting worker’s compensation investigations on the Main Line. Our investigators guarantee precise, professional results, completing each investigation with accuracy, speed and a commitment to excellence.
If you need help investigating workers’ compensation fraud on the Main Line, contact Know It All today.