Does workers' compensation fraud go up when the economy goes down?
According to the National Insurance Crime Bureau (NCIB) there is a strong link. In April 2009, the NCIB issued a press release stating that the number of suspected fraudulent
workers' compensation claims is up 71%.
What can employers do to help protect their businesses?
To help minimize the financial impact of fraud, experienced insurance companies have established anti-fraud programs as part of their claim management process. These programs are most effective when employers actively work with their
commercial insurance broker and carriers to identify potential fraud or abuse in their workplace.
What should employers look for?
The red flags, some of which are listed below, help identify activities that have historically proven to be indicators of fraud. If one or more of these indicators is present when an injury is reported, employers should notify their insurance carrier so they can investigate the validity of the claim.
• If an accident or injury occurs late on a Friday afternoon (especially if not reported until Monday) or early on a Monday morning.
• If the accident or injury lacks witnesses, or occurred in an area not frequented by the employee.
• If the injured worker is unusually familiar with the workers' compensation system or terminology.
• If the injured worker is retiring, on probation, involved in a labor dispute, disgruntled, a poor job performer or subject to disciplinary action.
• If the injury complaints are inconsistent with the facts of the accident. • If the injured worker was experiencing financial difficulties prior to submission of a claim and inquiries about a quick claim settlement.
• If the injured worker refuses medical tests or examinations to confirm an injury.
• If the injured worker stays out of work longer than the doctor prescribed.
• If the injured worker protests excessively about a modified position or returning to work and never seems to improve.
