While most workers compensation claims are valid, there is still the possibility of fraudulent claims that your business needs to look out for. One workers compensation claim can cause the cost of your insurance to rise dramatically. Looking for the signs of a fraudulent workers compensation claim, can help protect your business from lawsuits and rising workers compensation insurance costs.
Here are six common ways to identify fraudulent claims:
- Late reported claims. Claims reported more than 7 days after the injury tend to be dramatically more expensive and have a much higher lawsuit rate. Ask yourself and the employee, why did they report the claim so late? Investigating an injury shows you treat these matters seriously and helps stop potentially fraudulent claims from happening a following time.
- Monday morning reported claims. Make sure to pay attention to what your employees hobbies are and what they do on the weekends. Don’t be afraid to ask the injured employee if they had anything happen over the weekend. Read the employees body language and watch for any signals signifying that they are lying.
- Unwitnessed injuries. Not every injury is going to be witnessed but most fraudulent claims will be unwitnessed. Find out if they were in an area where they were not supposed to be and who saw the employee following the injury.
- Refusing medical testing. Most lying employees will prefer to see a chiropractor or physical therapist compared to getting an MRI or X-Ray. These employees will not want to be diagnosed due to their lack of injury, so they will prefer to go right to the treatment process.
- Vague description of the incident. Ask as many questions as possible. Listen and write down all their answer. Do their answers make sense? Does the body part that they injured seem to coincide with how they said the injury occurred? By asking more questions, you will begin to notice overlaps in the employee’s story.
- Chatter. Go to the department where the injury occurred and talk with other employees. Always show your employees your concern for the injured worker and see how they react. If the other employees roll their eyes or ignore your concern, pull them aside and listen to their recollection of what happened.
Remember, you don’t want to convict an injured employee of a fraudulent workers compensation claim. There is always the possibility of it being legitimate. Always pay attention to the signs of fraudulent claims, and report what you know to your claims adjuster.
NorthEast Insurance Services’ goal is to protect your business with the proper coverage. To learn more about our workers compensation insurance, contact Joseph Syndennis at (732) 972-1771 ext. 1104.