Watch Out for These Signs of Workers Compensation Fraud

Don’t become the victim of workers compensation fraud.

As a business owner, minimizing your workers compensation insurance costs is a matter of great importance.  One of the best ways to keep your costs down is by cutting down on instances of fraud.  But how can you tell when an employee is trying to scam you?  Here are some of the red flags that you should look out for.

Signs of Fraud from the Injured Employee

Oftentimes, the employee’s behavior will give away their fraudulent activities.  If the employee that is claiming injury does one or more of the following, then this could indicate that they are attempting workers compensation fraud.

  • The employee reported the injury late, or only reported the injury to their employer after reporting it to the state commission or an attorney.
  • The employee fails to attend weekly meetings.
  • The employee is uncooperative. For instance, they refuse to accept modified or transitional job duties.
  • The employee is difficult to contact, especially during regular workday hours.
  • The employee only has a postal box address rather than a home address.
  • The employee consistently misses doctor appointments.
  • The employee has been known to perform seasonal activities, hobbies, or work.
  • The employee has moved away.
  • The employee disputes the average weekly wage due to additional income.
  • The employee files for workers compensation benefits in a state other than the main location where the accident supposedly took place.
  • The employee disputes the information their employer offered on the “First Report of Injury” notice.
  • The employee refuses to cooperate in the claim investigation.
  • The employee has an unstable work history.
  • The employee has recently been fired, demoted, or passed over for a promotion.
  • The employee has a prior history of injury management or liability claims.
  • The employee makes excessive demands or seems to be pushing for a quick settlement.
  • The employee carries minimal or no health insurance.

Signs of Fraud from the Medical Authorities

In some cases, the main medical officer overseeing the employee’s injury can give away the fraudulent nature of the claim.  The following signs can indicate that the employee is faking the injury:

  • The medical reports are repetitive and indicate constant pain with only conservative treatment recorded.
  • The term “disproportionate” is used in the medical reports. For instance, “The employee’s pain seems disproportionate to the injuries sustained.”
  • The doctor mentions that there is “facial grimacing.”
  • Positive Waddell Tests (tests for lower back pain) are mentioned.

If you want to cut down on instances of workers compensation insurance fraud, then here are some of the red flags that you should watch out for.  Do you need help with your workers compensation coverage?  If so, then contact the experts at PMC Insurance Group.  Our dedicated team is eager to assist you with all your coverage needs today.

By PMC Insurance Group

Since 1996, PMC Insurance Group has worked to help independent agents grow their client base by offering workers' compensation solutions for a wide array of businesses. As one of the most distinguished workers' compensation wholesalers in the country, we have the tools and resources to help you create coverage programs for both small businesses and large accounts.