Purchasing worker’s compensation insurance brings with it a two-fold advantage: If one of your employees is injured on the job, the costs of his or her’s lost wages and medical expenses will be paid. In exchange, the employee cannot sue you for negligence. Although worker’s comp coverage can be costly, it is worth the expense – unless pervasive fraud occurs. Learn about the red flags that can signal this type of insurance abuse.
Questionable Legal and Medical Help
If you notice that several of your employees have gotten injured recently and all of them are seeing the same medical or legal providers, it’s time to raise your level of alertness. For a growing number of unscrupulous doctors and lawyers, pursuing fraudulent claims is their bread and butter.
Another harbinger of fraud is descriptions of the injury or accident that conflict. If your employee’s medical history says one thing and the injury report states another, be warned. It could mean that an unscrupulous provider is massaging the data.
Speaking of providers, you should also worry if your employee refuses to get a diagnostic evaluation from a different doctor. In a case such as this, you can’t help but to ask yourself what he or she is hiding.
Timing is Everything
You should hear warning bells if a report is made on a Monday morning, implying the injury happened over the weekend. Also be on alert if the person makes a worker’s comp claim about an accident or injury that occurred just before or after a job was terminated, before an employee strike or a layoff or at the end of seasonal work. Furthermore, unscrupulous claims are often filed long after the alleged incident occurred.
This next warning sign comes under the category of “if a tree falls in the forest and no one is around to hear it, does it still make a sound.” It is definitely suspicious if there are no witnesses to the accident or injury, especially if your employee’s description is inconsistent or vague. Be even more skeptical if this person has a history of worker’s compensation claims, often changes medical providers and moves from place to place on a regular basis.
While many claims are absolutely legitimate and deserve immediate and comprehensive attention, worker’s compensation fraud is a constantly growing problem in this country. If you become a victim, particularly if several of your employees file bogus claims, you can experience significant raises in the cost of your worker’s compensation premiums. Remaining vigilant and proactive is one of your best weapons.