Workers’ compensation insurance fraud is a major problem for most companies in the U.S. It can lead to significant losses, both financially and in terms of employee morale. It’s important to be aware of the warning signs to help protect your company from insurance fraud.
Keep on reading, as this guide will assist you in recognizing these signs and protect your company from possible financial losses.
Injured employees who return to work quickly.
One red flag is if an employee claims an injury but then quickly returns to work. In these cases, the employee may be exaggerating the severity of their injury, or they may be participating in fraud. Ensure to monitor employees who claim an injury but return to work without medical treatment. It could be a sign of a fraudulent claim.
Lack of details in the injury report.
Another way to spot potential fraud is to look for discrepancies in the injury report. This includes variations in the injury’s date, time, and location. The lack of clear details signifies that the employee is attempting to file a false claim. Be sure to review all injury reports for accuracy and clarity before proceeding.
Injuries that are not job-related.
Another common warning sign is injuries that are not job-related. Such a sign can indicate fraud within your organization. For example, a worker may claim to have injured their back lifting heavy equipment when the injury occurred outside work hours. Additionally, workers may claim to have injured themselves on the job but fail to report any prior complaints or injuries.
Injured employees who refuse medical treatment.
It’s also advisable to look out for an injured employee who refuses medical treatment or won’t follow the doctor’s recommendations. A worker failing to get the recommended medical care can be a sign they are lying about their injury. You should monitor any employee claiming a work-related injury for inconsistencies in their behavior and how they adhere to medical appointments.
Injured employees who refuse light-duty work.
Some employees are injured but wouldn’t agree to take on light-duty work, despite being medically cleared to do so. This could signify malingering or feigning illness or injury to receive workers comp payments. Be sure to investigate the situation further and document any findings.
Employees with a history of filing workers’ compensation claims.
Lastly, looking out for employees with a history of filing workers’ compensation claims is crucial. If a person has filed multiple claims in a short time or across multiple companies, it may indicate that they are gaming the system for insurance fraud. Additionally, keep an eye on employees who submit claims with unusually high payments or benefits.
You should verify any claims made and investigate them thoroughly. Also, ensure you communicate clear expectations to your employees when filing workers’ compensation claims and investigate any discrepancies.
Protect your company before it’s too late.
No one wants to experience workers comp insurance fraud in their company. With the tips above, you can protect your business from fraudulent activity. If you are suspicious of any behavior or notice any warning signs, report it to the proper authorities. Taking the necessary steps to be aware of potential issues can save your company from a costly and stressful situation.
