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Work Comp Fraud Top 10 Warning Signs

The Top 10 Warning Signs

All of us have encountered those questionable claims arising in the workforce. Those claims which seem to be too coincidental, too timely after a employee write up, too close to when a time off request was denied.....and more. Here are some warning signs which the Dept. of Industrial Relations have gathered over the years which support a possibility of a false claim.....

  • Monday Morning Reports: The alleged injury occurs first thing on Monday morning, or the injury occurs late on Friday afternoon but is not reported until Monday.

  • Suspicious Providers: An employee’s medical providers or legal consultants have a history of handling suspicious claims, or the same doctors and lawyers are used by groups of claimants.

  • Conflicting Descriptions: The employee’s description of the accident conflicts with the medical history or first report of injury.

  • Treatment is Refused: The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.

  • Claimant is Hard to Reach: The allegedly disabled claimant is hard to reach at home.

  • Employment Change: The reported accident occurred immediately before or after a strike, job termination, layoff, end of a big project or at the conclusion of seasonal work.

  • No Witnesses: There are no witnesses to the accident and the employee’s own description does not logically support the cause of injury.

  • History of Claims: The claimant has a history of a number of suspicious or litigated claims.

  • Late Reporting: The employee delays reporting the claim without a reasonable explanation.

  • Changes: The claimant has a history of frequently changing physicians, changing addresses and numerous past employment changes.

If you feel you have been on the receiving end of one of these situations or you just need a 3rd party to take a look at a situation, contact us.....WE WILL HELP!

Tel 909-481-7223

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Tel: 909-481-7222
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