15 Workers' Compensation Warning Signs

Experience shows a claim may be fraudulent if two or more of the following factors are present:

1. Monday Morning: The alleged injury occurs either “first thing Monday morning” or late on a Friday afternoon but not reported until Monday.

2. Employment Change: The reported accident occurs immediately before or after a strike, a layoff, the end of a big project, or at the conclusion of seasonal work.

3. Job Termination: If an employee files a post-termination claim:

· Was the alleged injury reported by the employee prior to termination?

· Did the employee exhaust their unemployment benefits prior to claiming workers’ compensation benefits?

4. History of Changes: The claimant has a history of frequently changing physicians, addresses, and places of employment.

5. Medical History: The employee has a pre-existing medical condition that is similar to the alleged work injury.

6. No Witnesses: The accident has no witnesses, and the employee’s own description does not logically support the cause of injury.

7. Conflicting Descriptions: The employee’s description of the accident conflicts with the medical history of First Report of Injury.

8. History of Claims: The claimant has a history of numerous suspicious or litigated claims.

9. Treatment is Refused: The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.

10. Late Reporting: The employee delays reporting the claim without a reasonable explanation.

11. Hard to Reach: You have difficulty contacting a claimant at home, when they are allegedly disabled.
    

12. Moonlighting: Does the employee have another paying job or do volunteer work?

13. Unusual Coincidence: There is an unusual coincidence between the employee’s alleged date of injury and their need for personal time off.

14. Financial Problems: The employee has tried to borrow money from co-workers or the company, or requested pay advances.

15. Hobbies: The employee has a hobby that could cause an injury similar to the alleged work injury.