After a workplace accident, workers’ compensation (WC) insurance can protect a business and the injured party.
But it’s not entirely impossible to find loopholes in the system.
Some employees take advantage of them to commit workers compensation claim fraud. How can you point out a WC scam? Watch out for these red flags.
The Incident is Reported Late
When an employee suffers an on-the-job injury, they are likely to report it straight away. Some can wait a few days due to fear of the insurance denying the claim outright. However, filing the claim weeks after an accident is a warning sign that it could be fraudulent.
There Are No Witnesses
If no one witnessed the workplace accident your employee claims injured them, they could be lying. But that’s not always the case for those working in solitary environments. To prove a claim is legitimate, you can request medical records and more information regarding the incident.
Claimant Provides Conflicting Descriptions
An employee filing a false claim can provide sketchy details about the accident. They may give conflicting information about the date and time of the incident, the location, or the injuries they suffered.
If you ask them questions about the accident, they might provide vague answers. This indicates they could be taking you for a ride.
Has Committed Workers Compensation Claim Fraud Before
You can dig into a claimant’s past to unveil an insurance scam. Employees with a history of filing fictitious claims are more likely to commit the crime again.
Of course, dismissing their report based on their past might seem unfair. Thus, looking into the alleged accident before compensating them for the work-related injuries is the best course of action.
Injured Party Refuses Treatment
Failure to see a doctor is another tell-tale sign that you have a WC scam on your hands. An employee can say no to a medical evaluation because they are afraid the physician can’t corroborate their story. In such an instance, they may also refuse to provide medical records to prove their injuries.
The Employee is Disgruntled
The chances of an unsatisfied employee committing insurance fraud are high. They could be seeking a monetary reward to help them get by after bowing out.
To know if an employee is unhappy, look for warning signs like absenteeism and poor work quality. Again, a team member who wants out may act up at company events and exhibit social withdrawal.
Changes in Personal Information
Find out if a claimant has a history of changing their personal information. You have a good reason to suspect insurance fraud if they use different names, move around a lot, and change their phone numbers often. Such an employee may be unreachable when supposedly at home recuperating.
Final Word
These are the most common indicators of a potential workers compensation claim fraud. But one or two signs are not enough to confirm an insurance scam. If you still have suspicions, launch an investigation to determine whether the claimant is genuine. You should also alert the parties involved, such as the employer.
