Worker Compensation Fraud: 10 “Red Flags” to Watch for

Running a business in these competitive times can be fraught with risk. Not only due to outside forces such as competition and market fluctuations, but internally, by employees who, for whatever reason, file a claim for worker compensation. The question becomes: is the claim legitimate or fraudulent?

Lawsuits have become part and parcel for doing business in the 21st century. But at Claytor Investigations, we work to protect your interests. Our investigative services can help you gather intelligence and necessary information in pending claims and lawsuits so that you can prevent your business from being taken advantage of.

While there is no exact science to identifying claim-related workers’ compensation fraud, here are potential warning signs:

  1. Strategically-timed injury reports – The alleged injury occurs first thing on Monday morning, or the injury occurs late on Friday afternoon but is not reported until Monday.
  2. Employment change – The reported accident occurs immediately before or after a job termination, layoff, end of a big project or the conclusion of seasonal work.
  3. Suspicious providers – An employee’s medical providers or legal consultants have a history of handling suspicious claims.
  4. No witnesses – No witnesses to corroborate the story of the accident.
  5. Differing accounts – The employee’s description of the accident doesn’t reflect the injury report.
  6. Frequent “flyer” – The claimant has made multiple suspicious claims in the past.
  7. Refuses treatment – The claimant refuses to be seen by a doctor regarding the injury.
  8. Late reporting – A delay in reporting the claim without a reasonable explanation.
  9. Missing in action – The allegedly disabled claimant hard to get in contact with.
  10. On the move – The claimant has a history of frequently changing doctors, home addresses or jobs.

History shows that when there are two or more “red flags” in a compensation claim, there is a chance the claim may be fraudulent. At Claytor Investigations, we are experienced, licensed and insured, and dedicated to uncovering the facts for you and your business. For more information, give us a call today.

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