7 Common Signs of Workers’ Compensation Fraud

Warning Signs of Workers’ Compensation Fraud in San Diego, CA

In San Diego, workers’ compensation insurance is supposed to provide help to workers who get hurt while on the job, but some employees take advantage of the system. According to the National Insurance Crime Bureau, businesses lose billions of dollars each year due to fake workers’ compensation claims. Watch out for these seven signs of workers’ compensation fraud to see if you need to investigate a claim.

1. The Accident Goes Unreported

A late reporting of the injury may be a sign the employee has ulterior motives. Unless the employee has a reasonable explanation for why he or she could not immediately report the injury, be wary of this sort of claim.

2. Claimant Refuses Treatment

People who actually need workers’ compensation will normally seek out medical assistance for their real health problem. When claimants repeatedly refuse to go to the doctor or get certain diagnostic procedures done, they may be doing this because they know a doctor would be able to tell they are uninjured.

3. Suspicious Descriptions of the Accident

Pay attention to how the employee describes the occurrence of the injury, and see if it seems logistically possible. If you can recreate the accident without injury, check to see how likely it is. You may need to be particularly suspicious if there are no witnesses to corroborate the employee’s claim. Most fraudulent claims are unwitnessed claims.

4. Employee Recently Requested Time Off

Try to see whether the employee has recently asked for time off for a vacation or another personal situation. Be on the lookout for denied requests for time off during the period the worker ended up getting injured. In some cases of fraud, the employee starts by faking an injury to get the desired time off, then decides to also file for compensation.

5. Other Likely Causes of Injury

Learn a little about the claimant’s history to see if they work at other jobs or have hobbies that could cause a similar injury. This could be a sign the employee became injured during personal time and wants the employer to pay for it.

6. Injuries Reported on Mondays

Statistically, a lot of fraudulent claims are for injuries that were reported on Mondays. Some people are restless after a weekend off, so they are more likely to turn to fraudulent means of making money. This sign of workers’ compensation fraud is particularly suspicious if the person claims he or she was injured late Friday and did not report it until Monday.

7. Claimant Is Undergoing Employment Issues

People who are laid off or have their hours reduced may feel a sense of annoyance or entitlement that leads them to fraudulent attempts to get money from their employer. Workers’ compensation fraud often occurs shortly after a person has been terminated, demoted, or removed from an important project.

If you run a business and need workers’ compensation insurance or another form of commercial insurance, San Diego, CA, is home to American Tri-Star, a reliable insurance agency. We also offer affordable auto, home, health, and bond insurance. Call 619-272-2100 today to speak with one of our friendly agents.