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From Our Blog

What Can You Do to Combat Workers’ Compensation Fraud?

A man employed as a concrete cutter in California filed a workers’ compensation claim, alleging injuries so severe he had lost the use of one arm.

After missing 3 months of work, he was videotaped giving skydiving lessons, showing zero ill effects from his supposed injuries. The man was observed boarding a plane, carrying skydiving equipment and landing a parachute with a student attached to his body.

Each year, workers’ comp scam artists rob employers of billions of dollars in unnecessary claims and compound the suffering of those employees who actually do experience on-the-job injuries, according to the National Insurance Crime Bureau.

Workers’ comp fraud may include (1) exaggerating the severity of an illness or injury, (2) filing claims for injuries that occurred away from work or (3) completely fabricating injuries that never even happened in the first place.

It’s important to know the possible signs of a workers’ comp scam in your organization, how to reduce the risk and how a professional investigator can help you uncover the truth.

Watch for Workers’ Comp “Red Flags”

While none of the following examples is enough to conclusively prove workers’ comp fraud, they do warrant closer investigation to verify the credibility of an employee’s claims.

  • Reported injuries are inconsistent with the employee’s title or duties, or the employee’s description contradicts medical tests, injury reports or witness testimony.
  • There are no witnesses to the alleged incident.
  • The claimant refuses diagnostic procedures or medical treatment.
  • There is a delay between the alleged incident and when the employee files the claim.
  • The timing is suspicious. Scrutinize claims filed on a Monday morning, and those filed just before or after a job termination, layoff or conclusion of a contract period.
  • The claimant is hard to reach or doesn’t return phone calls, emails or other contact methods.
  • There is evidence of activity inconsistent with the alleged injury. Example might include strenuous exercise or working a side job.
  • The employee has a history of frequent or suspicious claims, or frequently changing jobs, doctors or addresses.

Lower Your Risk of Workers’ Comp Fraud

As serious as workers’ compensation fraud is, there are things you can do to reduce the risk to your business.

  • Start with the hiring process. Conduct thorough background checks that include the candidate’s history of workers’ compensation claims.
  • Install security cameras throughout your place of business, and use them to verify claims.
  • Establish and communicate a zero tolerance policy for workplace injury fraud.
  • Encourage employees to report suspected fraud.
  • Offer rewards for whistleblowers and protect them from retaliation.
  • Provide workers’ comp fraud training.
  • Monitor the social media accounts of claimants for evidence that contradicts the alleged injury.

Investigate Suspicious Claims

What if an employee reports an injury but the facts just don’t seem to add up? If you notice any red flags, you need complete information before you can draw any conclusions.

An experienced professional investigator will know how to uncover the evidence you need to determine whether the worker’s alleged injuries are legitimate, or whether you have a case of fraud on your hands.

Evidence may include details about the claimant’s residence and vehicles. Video recordings and still photography can be used to document the subject’s lifestyle and uncover evidence of fraud.

You will receive a detailed report that can be used in court or other legal proceedings if necessary.

Are you concerned about possible workers’ comp fraud? Contact Robert Cirtin Investigations today.

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