Top 10 Signs of Workers’ Comp Fraud


fraudDid you know that workers’ compensation fraud is the fastest growing type of insurance fraud? According to the National Insurance Crime Bureau, it also happens to cost about $7.2 billion in losses each and every year. Employers and insurance providers can avoid becoming victims by knowing some of the red flags that may help them identify and address such fraudulent claims quickly and effectively. Here are the top 10 signs to watch for.

1) Employee has a long history of similar claims. If a person is particularly litigious, it could be an indication that they are a serial offender and may be attempting to perpetrate a workers’ comp fraud case.
2) Recent employment change. Many fraudulent workers’ comp claims are filed shortly after an employee has left the company, particularly if the job ended due to a layoff or termination. This can be retaliatory in nature and a reason to look into the case further.
3) Injury is reported on a Monday morning. Obviously, legitimate cases can occur on a Friday or a Monday, but insurance provider Employers has found that when a workers’ comp report is filed on a Monday morning following an alleged injury that occurred either that day or the previous Friday afternoon, the chances of fraud are higher.
4) Physician and/or legal representative is suspicious. In addition to looking for a history of claims by the employee, the claimant’s medical provider or legal council should also be checked out. If either has a background of suspicious activity, you could have a workers’ comp fraud case on your hands.
5) Delayed reporting. If an employee attempts to file a workers’ comp claim well after the supposed incident occurred, it could be a red flag.
6) Lack of witnesses. There could very well be legitimate cases where an employee is hurt in the absence of any witnesses, but such events should be investigated to be certain.
7) Conflicting details. If the employee’s account of what happened does not coincide with the evidence, witness testimony or medical reports, there may be reason to dig deeper.
8) Refusal of treatment. An employee that was legitimately injured on the job should receive prompt medical attention so that the entire incident can be properly documented. When said employee refuses to seek treatment, it could be an indicator of workers’ comp fraud.
9) Difficultly reaching claimant. When a claimant is hard to get ahold of, particularly when he or she purports to be home due to an on-the-job injury, there may be reason to be suspicious.
10) Frequent changes in personal life. A person who frequently changes jobs, addresses or doctors may be more likely to commit workers’ comp fraud.

If you suspect that an employee (current or former) is perpetrating workers’ comp fraud, the best place to start is by enlisting the help of an experienced private investigator. Doing so can help uncover the information you need to avoid further losses. If you’d like to learn more, give us a call and let’s discuss your concerns in greater detail.