How to Spot Workers’ Compensation Fraud

Author: di_admin

It is important to know how to protect your business from scams. Unfortunately, some employees can make false workers’ compensation claims that can create enormous damage to your business and negatively impact those who truly need assistance. Although workers’ comp is necessary for accidents that happen in the workplace, it is important to be informed about the different ways employees commit fraud and potentially put an end to these fraudulent claims.

Faking an Illness

An employee may completely fabricate an illness with no symptoms to show for it. You don’t want to jump the gun on any accusations, but you may want to hire a professional to do the deep investigation work. It is crucial to report anything and everything, check what types of activities are allowed by their doctors, and get an outside medical opinion on every reported case.

Made Up Injury

In filing a workers’ compensation claim, the employee will likely have to tell the story of how they were injured multiple times. If there is ever any contradiction in their account of how the injury occurred, you should take notice and investigate further. If some parts of the story aren’t adding up, then the story may not be true. It can be difficult for them to remember details of a false story, so keeping an eye on these small details is often the key to determining whether an incident actually happened. In addition to the employee, ask other employees (even if they weren’t eyewitnesses), as having multiple people’s accounts can create a fuller picture of the incident.

Using an Old Injury

It has been reported that some workers have used old injuries to their benefit. They may have injured their knee in the past and blamed any lingering issues on their current job. Apply security cameras, ask witnesses for their side of the story, get a copy of their medical history, and get a second opinion from a medical professional.

Social Media Posts

You may even catch the claimant red-handed. Keep an eye out on the employee’s social media posts after a workers’ comp claim is filed because you may see them post statements on their personal pages that don’t go along with their claim.

Lack of Communication

If an employee isn’t being very cooperative with the Human Resources department, physicians, and caseworkers, that generally reflects on the truth of the claims. It is not always easy to know if an employee is lying, but being on guard and digging for details may help. Pay close attention to those details within the claim and how willing they are able to give details to caseworkers. If they are genuinely injured or ill, they should be willing to help with the process and be easy to work with.


About Daniels Insurance, Inc.

At Daniels Insurance, Inc., we have a unique understanding of the risks that businesses like yours face on a regular basis. With the backing of our comprehensive coverages and our dedication to customer service and quick claims resolution, your business will be fully protected. For more information, contact us today at (855) 565-7616.