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.
  1. 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.
  1. 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?

  1. History of Changes: The claimant has a history of frequently changing physicians, addresses, and places of employment.
  1. Medical History: The employee has a pre-existing medical condition that is similar to the alleged work injury.
  1. No Witnesses: The accident has no witnesses, and the employee’s own description does not logically support the cause of injury.
  1. Conflicting Descriptions: The employee’s description of the accident conflicts with the medical history of First Report of Injury.
  1. History of Claims: The claimant has a history of numerous suspicious or litigated claims.
  1. Treatment is Refused: The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
  1. Late Reporting: The employee delays reporting the claim without a reasonable explanation.
  1. Hard to Reach: You have difficulty contacting a claimant at home, when they are allegedly disabled.
  1. Moonlighting: Does the employee have another paying job or do volunteer work?
  1. Unusual Coincidence: There is an unusual coincidence between the employee’s alleged date of injury and their need for personal time off.
  1. Financial Problems: The employee has tried to borrow money from co-workers or the company, or requested pay advances.
  1. Hobbies: The employee has a hobby that could cause an injury similar to the alleged work injury.

1 comment:

Patti said...

Most excellent...I linked to this.

I know far too many aides and nurses, and others, who seem to get hurt at odd times and end up out on WCL for months on end. Positions must be held for the employee who has been hurt...and we work short cause of this! Or the light duty game must be played. For those who really DO get hurt end up feeling guilty and tend to not report the injuries. There has to be a better way I just don't know what it is.