Employee Workers’ Compensation Claims: Red Flags to Watch For

When you work closely with your employees every day, you start to develop a relationship with them and might even consider them to be friends. This can make it difficult to see the red flags when the person files a fraudulent workers’ compensation claim.

Unfortunately, workers’ compensation fraud happens, and it can leave you and your business at risk. There are signs you should watch for that may indicate the claim is not legitimate. These can include:

1. No One Witnessed the Injury.

When an injury takes place, it’s essential to have an employee fill out paperwork immediately and name any witnesses to the incident. If there were no witnesses – or if the only bystanders were the employee’s close friends, this can raise flags. It can be especially suspect if the employee typically works around others and no one happened to be near when an injury occurred.

2. They Didn’t Immediately Report the Injury.

All injuries should be reported to management as soon as they occur. If the injured employee didn’t report the incident immediately – especially if they went home before making the company aware – it can indicate the claim might not be legit, or that the injury occurred elsewhere. Your company policy should include strict instructions on when to report injuries, who needs to be informed, and what to do when medical attention is needed.

3. They Are Disgruntled.

Is the employee upset about a recent disciplinary action, or being passed up for a raise or promotion? This can motivate them to want to “get even” with the company and try to file a fake worker’s compensation claim in retaliation.

4. They Can’t Keep Their Facts Straight.

After an injury, the injured employee should immediately state the details of the incident and the injury in a report. You should then also question the employee later to get a verbal retelling of the accident. If the employee’s account differs from what was initially provided, this can be a flag that it’s a fake claim.

5. They Are in Financial Trouble.

Is the employee struggling to make ends meet and needs a financial boost? This can be a motivator to commit worker’s compensation fraud.

6. They Have Risky Hobbies.

Note what hobbies the employee participates in outside of work – especially if the injury was reported on a Monday. Someone could be injured outside of work and then tried to pass it off as a work injury on their next shift. If they work a second job, you should also be aware that they could have gotten injured at that workplace as well.

7. They Are Aggressively Pursuing the Worker’s Compensation Case.

If they are very eager to settle their claim and get compensation, it should start to raise flags.

8. Their Medical Records Are Questionable.

If they provide you with medical documentation that seems sketchy, you should look into it further. Some companies might want to consider having all cases seen by a specific hospital or clinic to ensure the evaluation is legit. Some doctors might also help fudge worker’s compensation documentation, so it’s important to involve your lawyer to ensure that the diagnosis and prognosis are accurate.

9. They’re Not at Home.

If the employee was granted time off to recover from the injury but you are unable to reach them, it should raise flags and can require further investigation as to whether they are hurt.

To protect yourself and your company from fraudulent workers’ compensation claims, it’s essential to hire a workers’ compensation attorney. A lawyer can help you spot red flags and can work with you to ensure claims are legit before you pay any benefits.

Why Hire Our Workers’ Compensation Attorneys

When you need a workers’ compensation attorney to assist with your employees’ workers’ compensation claims, let our experts help.

Ranked in the 2022 U.S. News – Best Lawyers® “Best Law Firms” list regionally in 12 practice areas, we have experts in many areas of law to give our clients top-notch representation. In business for more than a century, our firm can mix its experience with the ability to evolve with the changing times.

To get started, contact us at 844-682-7682 or info@johnstoneadams.com.

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