While most work comp claims are truthful, fraud can occur in any workplace. An employee might hurt his back working in his yard over the weekend, and then wait until Monday to file a fraudulent work comp claim.
So how can you tell when your employees are taking you for a ride? There are several signs that point to possible work comp fraud. While none of these signs are absolutely telltale, it is important to be aware so that you can better protect your business.
Signs of potential work comp fraud
- No one else was around to witness the injury occur
- Conflicting stories about the incident
- Inconsistency in symptom description and medical histories
- The employee refuses to see the assigned clinic, or their doctor is reluctant to provide information
- The injury is reported just before a job change
- There are no objective test results to support the diagnosis
- The employee seeks legal representation soon after the injury
- The employee is reluctant to speak with your claim coordinator
- They refuse temporary duty reassignments
Protecting your company against work comp fraud
Be sure to dig deep and verify that any claim is legitimate, no matter how trustworthy the employee might be. Workers’ compensation laws can be complicated, so consult a workers’ compensation attorney when you’re unsure about a claim.
Your next step in protecting your business is adequate preparation. With occupational medicine services like Physical Capability Exams, you can establish a baseline for your employee’s physical capabilities and medical history. If you know that your employee had a bad back before he started working for you, you’ll have a better chance at disputing his fraudulent claim. Aside from protecting against work comp fraud, PCE exams can also be helpful in decisions regarding job placement.