How to Identify a Fraudulent Workers Comp Claim

September 5, 2022 Stan

After filing a workers comp insurance claim for a shoulder injury he suffered working for the federal postal service, the recipient of the benefits was spotted working as a massage therapist. This led to felony charges related to the fraud.

An ‘injured’ entertainer was seen dancing in a popular television commercial while he collected a surplus of fifty thousand dollars in workers’ compensation payments related to a previous disability claim.

After submitting a workers comp claim about an injury incurred while on the police force and collecting more than thirty thousand dollars in benefits for it, the former officer was found to be working for a musical band – something he would not have been able to physically do if his injury claim was genuinely true.

If you delve deeper into it, you will find more and more bizarre stories about workers comp fraud. Thankfully, the ratio of these is quite slim in contrast to the valid ones. For small business owners and large commercial enterprises, it is vital to be in the know about detecting abuse of the system.

5 Ways to Understanding Workers Comp Fraud

1. Something may not be right when a worker files a worker’s compensation claim for an injury that supposedly occurred seven or more days before that.

Here’s what to do if this happens. Speak to the injured worker, as well as fellow employees to gather information about the incident and draw your theory of a conclusion.

2. A worker’s compensation claim that was filed immediately after the weekend may indicate the injury was incurred away from the work site.

This is what you should do if this happens. Investigate if the worker has interests in hobbies or sports activities that may have triggered the injury. Conduct interviews with the other employees to discern if they have any knowledge about whether the claimant partook in this type of weekend activity. Keep your eyes open for verbal or body language that demonstrates the worker is lying.

3. No witnesses of the injury could mean that the claimant is not genuine.

Here is what you can do in this case. Make the appropriate inquiries with others if anyone saw the claimant immediately following the said injury.

4. What if the claimant wants to be treated without getting an x-ray, MRI, or another injury-defining testing?

This is what you can do in this situation. Ask the claimant why he or she is not interested in documented diagnosis. Demand that he or she undergoes this required diagnostic testing.

5. Any claimant that does not offer a clear picture of what occurred when he or she was injured is subject to suspicion.

Here is what you should do in this scenario. Take all details of the report while using your knowledge of the usual state of affairs at your business site. Look out for any inconsistencies in his account.

If your findings about the above points do not justify the claimant, do not hesitate to bring your thoughts to the claims department of your insurance company.