Can you Name the Top 10 Workers’ Compensation Claim Red Flags?
Here's a list of the 10 most common red flags reported in workers’ compensation claims, according to www.workerscompensation.com.
1. Monday morning accident. Almost twice as many accidents occur on Monday morning than any other morning of the week. This is due to people claiming non-work-related weekend injuries as work-related to keep their income flowing.
2. Arriving early for work. Unless the employee habitually arrives early for work, arrival for work early on the day of the alleged accident is an indicator the employee wanted to “have the accident” before other employees were around to witness it.
3. Not seeing a hazard the worker had just seen moments earlier. If boxes on the floor were a common occurrence, the employee would be careful about watching where he or she was going. If a box on the floor was unusual, the employee would have made a mental note to avoid it.
4. The mechanism of injury does not make sense. If the employee was using both hands to carry a heavy box, how did the employee have a hand free to grab the storage shelf?
5. The accident was not witnessed. Bogus injury claims almost always occur where no one else will see the accident happen.
6. The selection of a particular doctor over a more qualified doctor who specializes in treating injured employees. This is normally a sign the employee wants a doctor who will accommodate his desire to be off work.
7. A doctor who does not address return to work. This is normally because the injured employee tells the doctor that he does not feel he will be able to meet his job requirements.
8. The employee being asleep when he would normally be awake. Unless the doctor has prescribed some very strong pain killers, the employee should be available to speak to the employer.
9. The employee not being at home. Occasionally, not home is understandable, repeatedly not home/not available is usually a sign the employee has something better to do than being at home, i.e., possibly another job, either short-term or long-term. Background noises that don’t sound like a spouse or a television often are an indicator the employee is working elsewhere.
10. Tips from co-workers. This is strong evidence of fraud and should be investigated thoroughly.
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