After filing a workers’ compensation insurance claim for a shoulder injury sustained while working for the federal postal service, the recipient of benefits was seen working as a massage therapist. This led to felony charges related to fraud.
An ‘injured’ entertainer was seen dancing in a popular TV commercial while collecting an excess of fifty thousand dollars in workers’ compensation payments related to a previous disability claim.
After filing a workers’ compensation claim for an injury sustained while on the police force and collecting more than $30,000 in benefits for it, it was discovered that the former officer was working for a music band, something he would not have been physically able to do. if his damage claim was genuinely true.
If you really dig into this, you’ll find more and more weird stories about workers’ compensation fraud. Fortunately, the proportion of these is quite small in contrast to the valid ones. For the small business owner and large commercial companies, it is vital to be aware of how to detect system abuse.
5 ways to understand workers’ compensation fraud
1. Something may be wrong when a worker files a workers’ compensation claim for an injury that allegedly occurred seven or more days earlier.
Here’s what to do if this happens. Talk to the injured worker as well as your co-workers to gather information about the incident and draw your theory to a conclusion.
2. A workers’ compensation claim that was filed immediately after the weekend may indicate that the injury occurred outside of the workplace.
Here’s what to do if this happens. Find out if the worker has interests in hobbies or sports activities that may have triggered the injury. Conduct interviews with the other employees to ascertain whether they have any knowledge as to whether the claimant engaged in this type of weekend activity. Watch for verbal or body language that shows the worker is lying.
3. Lack of witnesses to the injury could mean the claimant is not genuine.
This is what you can do in this case. Make appropriate inquiries of others if anyone saw the claimant immediately after said injury.
4. What if the claimant wants to be treated without having an X-ray, MRI, or other tests that define an injury?
This is what you can do in this situation. Ask the claimant why he is not interested in a documented diagnosis. Demand that he or she undergo these required diagnostic tests.
5. Any claimant who does not provide a clear picture of what happened when they were injured is subject to suspicion.
This is what you need to do in this scenario. Take in all the details of the report while using your knowledge of the usual state of affairs at your business site. Keep an eye out for any inconsistencies in your account.
If you find in relation to the previous points that the claimant is not justified, do not hesitate to send your opinion to the claims department of your insurance company.