WORKERS COMPENSATION FRAUD: How to Identify a Fraudulent Claim – Matthew Davis MBA, AAI

Written by on 10/20/2011 4:00 PM . It has 0 Comments.

According to some studies, roughly as many as 80% of all Workers’ Compensation claims filed are legitimate; meaning that nearly 20% (1 in every 5 claims) contains some element of fraud. 

This is why it is important as an employer to watch for these red flags that may indicate fraudulent Workers’ Compensation, or other types of claims:

-    Filing multiple claims

-    Longer absences than anticipated by the employee, combined with an unwillingness to return to work

-    Unwillingness to be assigned to other, lighter jobs within the company or to complete partial duties

-    Constantly missing medical appointments

-    Employee will not provide date, time or location of the incident that caused injury

-    Employee has no recollection of services provided for related medical bills

-    Lack of witnesses to an accident or incident

-    Employee cannot produce specific information about the nature of the injury

-    Employee has a history of short-term employment

If any of these red flags occur, it by no means makes the claim automatically fraudulent – these are simply guidelines to keep employers proactively evaluating the legitimacy of a Workers’ Compensation claim.  These red flags are intended to keep Workers’ Compensation fraud, and many actions commonly associated with fraud at the forefront of an employer’s Workers’ Compensation management process.

For more information regarding the potential signs of Workers Compensation Fraud and how to manage your Workers’ Compensation program, Talk To The Experts at GDI Insurance Agency, Inc. by calling 888-991-2929.

Matthew Davis MBA, AAI


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