Workplace injury and illness risks can differ widely from industry to industry. An employee at an accounting firm will face different risks than someone working construction or someone working as an airline pilot, and so on. But some basic risks, like slipping and falling or back injuries could befall anyone at any time, regardless of their work environment. And when a workplace injury takes place, the injured party is right to make a workers’ compensation claim. That is unless they’re committing fraud.
According to statistics from the National Insurance Crime Bureau, workers’ compensation insurance fraud costs businesses a collective $30 billion every year in the United States. Claim-related fraud, which is when an employee attempts to gain workers’ compensation insurance benefits by falsely stating they sustained an injury, ends up leading to higher insurance premiums for employers and can even hurt workers who legitimately suffer an injury.
To curb these fraudulent workers’ compensation insurance claims, employers can be on the lookout for certain red flags. Here are some items to keep an eye on when someone makes a workers’ compensation claim.
- Monday morning injuries: An alleged injury occurs first thing Monday morning, or the injury takes place late on Friday afternoon but isn’t reported until Monday.
- Employment change: The injury or accident is reported immediately before someone is fired, laid off or they quit.
- No witnesses present: There were no witnesses around to see the accident happen and the employee’s description is riddled with illogical gaps.
- Suspicious providers: An employee’s medical providers or consultants have a record of handling suspicious claims.
- History of claims: If the claimant has a history of making suspicious claims, especially for wide-ranging reasons.
- The claimant is hard to reach: If the claimant is hard to reach and seems shifty, they could be trying to pull something on their employer.
If there are two or more red flags present in a claim, there is a good chance the claim may be a fraudulent one or one that might need more investigating to make sure the individual isn’t falsifying any information.
If an employer suspects an employee may be committing a fraud on a claim, they should report this suspicious activity to their workers’ compensation insurance carrier. Businesses can establish a zero-tolerance policy when it comes to fraudulent claims and clearly lay out their expectations with employees through written anti-fraud policies.
Businesses should also consider creating an open and honest work environment where employees suspecting others of committing fraudulent claims can come forward as a silent witness, providing anonymous information about a possible fraudulent claim.
Workers’ compensation fraud is a serious offense that can have a major impact on business owners and their employees. By laying down expectations for employees and keeping an eye on possible red flags, businesses can see a more transparent atmosphere in their workers’ compensation insurance claims.
About InsureMyWorkComp
InsureMyWorkComp is a digital brokerage that helps clients find the right workers’ compensation solution for their business needs. Unlike other online platforms, we will help you to work with an agent who can provide you the right solution for your risk profile. Our staff has over 50 years of workers’ compensation underwriting and sales experience, and we are confident that we will provide you the support that you need. For more information or to get a quote, contact us today at (855) 340-9138.