The great majority of workers’ compensation claims are valid. So what can small businesses do to better spot claims by their workers that are fraudulent? Asking the right questions.
Here are six ways to identify fraudulent claims.
No. 6: Late reported claims. Claims reported more than 7 days after the injury tend to be dramatically more expensive and have a much higher litigation rate. Why did they report the claim so late?
No. 5: Monday morning reported claims. This seems obvious, but it is amazing how often these are accepted at face value. What hobbies does the worker have? Had they mentioned anything to their co-workers on Friday about activities they were looking forward to over the weekend?
No. 4: Unwitnessed injuries. Not every claim is unwitnessed, but most every fraudulent claim is.
No. 3: Refusing diagnostic procedures. Fraudulent claimants want treatment, not answers. If the claimant has a soft-tissue injury such as a back or neck injury, make sure that they seek treatment at a facility that can perform immediate testing.
No. 2: Vague description of the incident. Think of this as the smell test. Ask questions and ask yourself does what they are saying make sense.We understand that you are not a detective, but who knows the specifics of your business better than you do?
No. 1: Chatter. Go to the department where the injury occurred and talk with those who are left. Do they roll their eyes when you express concern that they are OK? If you get signals like this, sit down with those workers and get to the bottom of the story. Be careful not to incriminate the injured worker you are trying to get information, not disparage the injured worker.
Trust your instincts.Report what you know to your claims adjuster. Give them as many specifics as possible. By paying attention to the signs, and working closely with your claims adjuster and giving them all the facts, you will have done your part to make sure that you are not playing the fool.