Newsletters

August 2008

How to Spot Workers’ Compensation Fraud

The evidence of workers’ compensation fraud is causing great concern for employers across the country, and especially here in the Midwest. With the winter season fast approaching, construction companies are in the planning stages of laying off workers’, and the employees know it. Their concern of being unemployed for months at a time sometimes outweighs the consequences of defrauding their employer. This is a critical time for employers to understand the warning signs that can accompany the filing of a fraudulent claim.

The following list is a set of factors that should cause employers to view the claim with suspicion. If items on the list are applicable to an employee filing a claim, does not necessarily mean the employee is trying to defraud you, it simply means to approach the claim cautiously and carefully.

• The injury in question coincides with a layoff or termination.
• The person filing the claim is never home or available by telephone or has an unlisted phone number.
• The person filing the claim is active in sports.
• The person filing the claim has another job.
• The person filing the claim is in line for early retirement.
• The rehabilitation report contains evidence that the person filing the claim is maintaining an active lifestyle.
• The person filing the claim appears to have made a full recovery.
• The person filing the claim receives all mail at a PO Box and will not divulge a home address.
• The person filing the claim is in the field of carpentry, plumbing, or electrical, and their skills could be used to work on a cash basis while feigning disability.
• There are no witnesses to the incident in question.
• The demands for compensation are excessive.

• The person filing the claim has a history of filing.
• The doctor’s reports are contradictory in nature.
• A soft-tissue injury is claimed to have produced a long-term disability.
• The injury in question occurred during hunting season.

If one or more of these factors are present, you should investigate the claim carefully before proceeding. The factors alone will not eliminate fraudulent claims from occurring, but it is a great litmus test to identify claims that may become troublesome.

For a detailed “Red Flag Claims Checklist”, please request one from Hope Kjeseth at hjeseth@mninsurance.net.

Hope Kjeseth is a Certified Work Comp Specialist and claims representative with COMPTROL. She can be reached at 651.389.4018.

Back to Newsletters