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