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Workers Comp Claims: Tips to Avoid Fraud

 Frequent fraudulent claims have a significant effect on any type of business, large or small. A worker who falsely claims a disability or injury will impact the productivity of a company. The absence of the worker claiming injuries from the workplace creates a burden for the business owner and all other employees. Another problem that can arise is the companies experience modification on the businesses insurance rates. Any payments that are issued for workers comp claims are recorded. Insurance carriers take the claim history of a business into account when calculating rates and this may lead to an increase in coverage premium. It is very important that employers know the signs of fraudulent claims. The following is a list of red flags for possible employee claim fraud:

 

  • Time of Injury, if event occurs on a Monday – Employee may have been injured over the weekend

  • Delay in reporting the injury

  • Employee gives multiple versions of what and how the injury happened

  • No witnesses that the injury actually occurred when and how it is stated by the employee

  • Behavioral or disciplinary problems with employee in the past

  • Employee has past claims filed with prior employers.

 

One out of four insurance fraud claims in the U.S. is related to workers compensation policies. Keeping these tips in mind during an employee claim process will help business owners detect a falsely reported injury.