Business owners are fully aware that accident can and will happen in the workplace and when this happens that businesses liability will be on the line. Workers’ Compensation insurance is meant to protect you when accidents involving employees take place, but some employees and staff can take advantage of the system and commit workers compensation fraud.
Workers Compensations Fraud Statistics:
More than 94% of American businesses carry workers’ compensation insurance. That covers more than 135,000,000 workers across the United States.
In 2012 alone, there were roughly approximately 3 million non-fatal workplace accidents. That’s nearly 3 injuries for every 100 full-time employees.
While most claims are legitimate, studies indicate that 1 to 2% or more of all workers’ compensation insurance claims are fraudulent.
Common Types of Workers Compensation Fraud
The False Claim
Working While Collecting Benefits
Pre-Existing Injury Claim
The Exaggerated Claims
WORKERS COMPENSATION FRAUD RED FLAGS
Claims injuries that are inconsistent with facts about the accident
Provides multiple versions of how the accident occurred
Refuses medical tests or examinations to confirm an injury
Stays out of work longer than the doctor prescribed
Protests excessively about a modified position or returning to work
Has a prior history of dubious claims involving personal injuries?
Works a second job or owns a business
Files a workers’ compensation claim with a different employer
In a motor vehicle or other accident just prior to the alleged work-related injury
Is retiring, on probation, involved in a labor dispute, disgruntled, a poor job performer, or subject to disciplinary action
Can’t be reached at home while on disability
Is unusually familiar with the workers’ compensation system
States they found the attorney, doctor, or clinic through a hotline or an unnamed friend
If the accident or illness:
Occurs late on a Friday afternoon (especially if not reported until Monday) or early on a Monday morning
Is not associated with the employee’s job duties
Occurs in an area not frequented by the employee
Is not reported in a timely manner
Leads to rumors at work that the accident was staged or is illegitimate
If the medical provider and/or attorney:
Submits medical reports inconsistent with the employer’s first report of injury
Provides medical treatment inconsistent with injuries initially alleged by the injured employee
Submits billing records for treatment different than what was reported by the injured employee
Frequently treats an injured employee despite the fact the employee lives far from the clinic
Attributes new or additional medical problems to the original injury (i.e., added body parts)
Shows a pattern of working with the same doctor or attorney on a large volume of claims
Provides a letter of legal representation, or letter from a medical clinic, as first notice of claim
A red flag does not prove fraud even when several indicators are present. However, if you know what to look for, you might discover some troubling patterns.
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Francis & Associates
Private Investigations Agency
7455 Arroyo Crossing Parkway
Las Vegas, NV 89113
Phone: (702) 966-1261
Toll Free: (866) 653-3398
Fax: (702) 722-2009
NVPILB License: 1408