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Workers Comp Claim Red Flags

By May 27, 2015August 22nd, 2018

Spotting the red flags that indicate possible workers comp claim fraud is the best way to prevent it from happening.   While the majority of claims are truthful, the National Insurance Crime Bureau reports that billions of dollars of false claims are submitted each year.

Any one item on this red flag list doesn’t prove a claim is fraudulent however, if you find more than one on a single claim you should notify your insurance agent so they can act quickly.

  • Suspicious Timing: 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 layoff, the end of a big project or at the conclusion of seasonal work.
  • Job Termination: The alleged injury was not reported prior to termination or unemployment benefits were exhausted prior to filing a claim.
  • History of Changes: The employee has a history of frequently changing physicians, addresses and places of employment.
  • No Witnesses: The accident has no witnesses and the employee works around other people.
  • Fuzzy Details: The employee has difficulty remembering what happened and the description changes when inconsistencies are questioned.
  • History of Claims: The employee has a history of numerous suspicious or litigated claims.
  • Treatment is Refused: The employee 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 the employee at home, when he/she is allegedly disabled.
  • Unusual Coincidence: There is an unusual coincidence between the employee’s alleged date of injury and his/her 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.

If you’ve ever wondered if a workers’ compensation claim really happened at work, you’re not alone. By being aware of potential red flags taking immediate action, you can help control the cost of your workers compensation insurance.  For more information, contact the experts at The Flanders Group at 800-462-6435.