As the saying goes, accidents happen. An injury in the workplace can be costly for everyone involved, but what happens when an employee fabricates or exaggerates an injury? Unfortunately, worker’s compensation fraud is all too common in today’s workplace, and can be incredibly costly for business owners. Below are just some of the fraud warning signs you can watch out for to protect your company from fraudulent claims.
The employee’s story is inconsistent
One of the easiest ways to determine whether or not you’re dealing with worker’s compensation fraud is an inconsistent story from the employee in question. Are they constantly changing the details of the story? Did they tell their medical providers a different story, or are they omitting important details? It’s important to get all of the information of the reported accident on file to help protect you and your company from claims fraud.
It's important to get all of the information of the reported accident on file to help protect you and your company from claims fraud.
Try to ask other employees if they were present when the alleged injury took place and determine whether or not their account of the accident conflicts with the injured employee’s story. While there may be a reasonable explanation for why they are misremembering, you should take all necessary steps to validate and confirm every detail — especially when it comes to working with your insurance company.
There was no one there to witness the incident
What happens if there was no one, aside from the employee in question, there to witness the injured worker’s incident? Chances are, if you work in a labor intensive industry like construction or in a warehouse setting, your company policy has established safety protocols that require multiple people to be present for certain job functions and duties. If there are no additional witnesses to a work-related injury, it’s likely that insurance companies deny the comp claim. It’s also possible that the injury was obtained during personal time and not in the workplace.
The employee is waiting to report the incident
One reason you may question the validity of injury claims in your company is when the injury was reported. Late reporting and employee delays can be a serious red flag when it comes to false claims in the workplace, as it can be an indication that the injury did not actually take place on the job. Each state has a differing policy on when workplace injuries must be reported in order for the employee to receive compensation benefits.
Each state has a differing policy on when workplace injuries must be reported in order for the employee to receive compensation benefits.
The longer the employee waits to report the incident, the more difficult it becomes to prove or disprove that the injury occurred in the workplace.
The employee is refusing medical treatment
If an employee is seriously injured, they should not hesitate to seek medical treatment immediately. If they refuse to do so, it might be a sign they have something to hide — and may be attempting to receive unemployment benefits. If an employee is truly injured, they will take the natural next steps to heal and return to work. Insurance companies and health care providers can also be guilty of worker’s compensation fraud by claiming to provide medical care in order to be paid by the insurance company. It’s crucial to request proof of any medical expenses acquired throughout the claims process, as well as any past medical history.
They have an extensive history of claims
Using a private investigator can help determine whether or not the employee in question has a history of filing claims. By conducting comprehensive background checks, we can dive deeper into their past employment and claim history to expose potential patterns.
By conducting comprehensive background checks, we can dive deeper into their past employment and claim history to expose potential patterns.
How to handle a suspicious claim
Before you accuse an employee of fraud, you should take the necessary next steps to protect you and your business. Be sure to report the suspected employee to a state agency (this may differ from state to state). You can report a false injury claim, fraudulent insurance claim or other form of fraud to your designated agency. Be prepared to provide the name and address of the employer or business, and the name of the individual you are reporting.
Work with a Private Investigator
Despite knowing some of the warning signs of fraud, fraudulent claims can still slip through the cracks. In particularly difficult cases, you will likely need to enlist the help of experts in order to uncover the facts. If you have received what you believe to be a questionable claim, we can help. InQuest Solutions offers over 20 years of expertise, with a proven track record of success. Our association and relationships with multiple AM 100 Law Firms, International Insurance Carriers, Third Party Administrators, Self-Insureds, Fortune 500 companies and more speaks for itself. We pride ourselves on continuously evolving and adapting to new technologies to better serve our clients in today’s digital world.
Contact us today for a free case review.
