6 Ways to Detect Workers’ Compensation Fraud

By Will Temby

The security cameras in the company cafeteria captured it all.

The video shows a man dumped a cup of ice onto the floor, threw out the cup and then laid down on the floor as though he slipped on the ice.

Will Temby

Of course, there was no injury. Instead, the man was charged with insurance fraud and theft by deception.

You might not have a camera in your lunch room but there are a good number of red flags that can help you avoid becoming a victim of workers’ compensation fraud. Here are six:

  1. Monday morning reports. The alleged injury occurs first thing on Monday morning, or the injury occurs late on Friday afternoon but is not reported until Monday.
  2. Employment change. The reported accident occurs immediately before or after a strike, job termination, layoff, end of a big project, or at the conclusion of seasonal work.
  3. No witnesses. There are no witnesses to the accident and the employee’s own description does not logically support the cause of the injury.
  4. Conflicting descriptions. The employee’s description of the accident conflicts with the medical history or First Report of Injury.
  5. Treatment is refused. The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
  6. Late reporting. The employee delays reporting the claim without a reasonable explanation.

Experience shows that when two or more of these factors are present in a workers’ compensation claim, there is a chance the claim may be fraudulent. Remember, though, these are simply indicators. Many perfectly legitimate claims are filed on Mondays — and some accidents have no witnesses.