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  • Writer's pictureNathan Fredrickson

Are Your Employees Stealing from You? The Warning Signs of Work Comp Fraud

Although most workers’ comp claims are legitimate, even one fraudulent claim can significantly increase your company’s insurance premiums long after the claim is closed.

Below is a list of 15 warning signs of possible work comp fraud that should cause you to look more deeply into the claim.

  1. Monday Morning Injury Reports - The employee reports an injury that allegedly took place Monday morning or late on Friday.

  2. Employment Status - The accident is reported after the employee is terminated or part of a layoff.

  3. No Witnesses - Other co-workers were not present to corroborate the worker’s injury claim.

  4. Conflicting Report - The employee’s description of the accident is not consistent with the injury report or the medical provider’s description.

  5. Late Reporting - The employee neglects to inform his/her supervisor in a timely manner without explanation.

  6. Hobbies - The employee participates in outside work activities that could cause an injury similar to the claim.

  7. Financial Problems/Uninsured - The employee uses a work comp claim to treat an existing condition.

  8. Unusual Coincidence - The employee reports and injury around a time when he/sh has asked for time off.

  9. History of Past Claims - The employee has reported one or more past claim at a current or past employer.

  10. Lawyer Up - Shortly after being injured, the employee retains a personal injury attorney.

  11. Other Job - The employee works a second job or works for themselves.

  12. Difficult to Reach - The employee does not respond to phone calls or emails.

  13. Medical History - The employee has a pre-existing condition similar to the injury reported.

  14. Refusal of Treatment - The employee refuses to have the injury diagnosed by a medical provider.

  15. Suspicious Providers - The employee has chosen a medical provider that is notorious for enabling work comp claimants.

EPI Investigations and Risk Management, based in Sioux Falls, SD, provides comprehenive work comp management. Our experienced risk managers investigate and manage each work comp claim from the moment of the First Report of Injury to the claim's closing.

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