Workers’ Comp Fraud, The Red Flags

flag(Post written by Rick Dacri, March 16, 2016)

I received a call from a client bemoaning the fact that one of his “problem employees” was now claiming he hurt his back moving a box. The client is sure that it is fraud, because the day prior, this same employee was put on final warning for absenteeism.

Fraudulent workers’ comp claims can run havoc with any manager and company. While the actual amount of fraud in the system is relatively low (1%-5% of claims), it is still quite costly…and they make managers crazy.

Let’s talk about some of the warning signs that you and your supervisors should watch for. But first, let me briefly discuss malingerers. These are individuals who incurred a legitimate workplace injury, but stay out of work longer than needed. A good return to work strategy can quickly put an end to this, but in my experience, malingering is one of the biggest money drains in the system.

Now those workers’ comp red flags:

  1. Monday morning reports: Employees frequently injure themselves over the weekend, claim it happened at work, thus ensuring themselves additional time off and a steady stream of income. Watch for late Friday’s before a holiday too.
  2. No one saw it happen: Like the case I opened this blog with, these individuals get hurt and no one is there to verify it.
  3. Job hopper: These individuals frequently move from job to job, company to company, often incurring injuries in many of them. Good reference checking can often eliminate them, but remember, you cannot ask about workers’ comp injuries. Sorry!
  4. Late reporting: Watch for claims from employees who report injuries days or even weeks after they claim it occurred.
  5. Questionable medical provider: Make sure you can recognize the doc who treated and provided the medical reports. There are known docs and clinics that are not up and up. Second opinions are needed here.
  6. Refusal of treatment: When you try to send your “injured” employee to your doc and they refuse to go, this is a problem sign.
  7. Differing reports: Watch for conflicting stories when they are providing a statement. There should always be consistency.
  8. Can’t reach them at home: You know there is a problem when you call or visit and they are either not there or they won’t take your call.
  9. History of claims: When their workers’ comp file is thick with multiple claims, you have a problem.
  10. Disgruntled employee: When an employee is facing discipline, termination or lay off, watch for a grab for a final payday bonanza.
  11. No money: Employee facing financial problems, always borrowing from co-workers or asking for an advance, may eventually look at comp as their solution.

There are many other red flags to watch for when addressing claims. In my upcoming April 20 webinar (How to Quickly Cut Your Workers’ Comp Costs), I will be addressing in detail workers comp fraud warning signs and methods you can quickly employ to eliminate all fraud. Other aspects of workers’ comp will also be discussed. For info on the program, click How to Quickly Cut Your Workers’ Comp Costs or give me a call.

Other Posts you might want to read:



1 Comment

Filed under Compliance, Uncategorized

One response to “Workers’ Comp Fraud, The Red Flags

  1. Pingback: Workers’ Comp: What’s My “Mod”? | Uncomplicating Management

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s