Even though taking preventative measures can decrease instances of work-related injuries and illnesses, accidents happen and employees can get hurt or sick on the job. It’s important for businesses to have formal procedures and regulations governing the workers’ compensation claim process. A faulty system can expose employers to workers’ comp fraud.
While phony claims may vary, there are several warning signs employers should be aware of to avoid feeding into illegal activity, including:
The injury
- Injury is reported late
- Injury is first reported to an attorney, medical practitioner, governing body or other employees and not to the employer
- Claim is filed first thing Monday morning for an injury that occurred Friday afternoon
- There are no witnesses
- Symptoms cannot be proven by medical evidence because they include headaches, back pain, head trauma or stress
- The injury date coincides with the employee’s previously requested time off
- The employee’s injury description differs from a physician’s medical exam findings
- The details of the incident are vague or questionable
It’s important to investigate accidents. Employers should be mindful of employee character traits that might be potential warning signs for fraud.
The employee
- Fails to attend meetings and is uncooperative
- Has a negative attitude about work
- Is difficult to reach because he or she doesn’t answer the phone and doesn’t respond to messages
- Has a history of filing claims
- Files a claim shortly after being terminated
- Refuses medical treatment
- Changes physicians or care providers frequently
- Fails to attend medical appointments
- Has a history of financial troubles
With these potential red flags, employers may consider approaching each injury claim with a strict, uniform procedure. It’s important to remember the presence of these warning signs does not mean a claim is fraudulent.
When an incident occurs
An effective business policy requires employees report all injuries, no matter how minor, to their supervisor immediately after they occur. When an incident happens, it’s important to investigate it promptly and thoroughly.
If immediate medical attention is required, first aid should be administered by someone who is certified. A workers’ compensation insurance claim should be filed according to the respective state’s workers’ comp regulations.
Employers may refer the injured worker to a preferred medical facility designated by the business’ workers’ compensation insurance provider. It’s also a good idea for the employer to explain to employees the workers’ compensation coverage early on to open the lines of communication between employers and workers.
Founded in 1925, CopperPoint Insurance Companies is a leading provider of workers’ compensation and commercial insurance solutions operating in six southwestern states. To learn more about our insurance products and find resources to better manage your risks, explore our website or contact your independent insurance agent.
