How to Detect Possible Workers’ Compensation Fraud

Twenty-five percent of all United States insurance fraud claims are related to workers’ compensation. Employees throughout the country report about $7 billion worth of personal injuries occurring in the workplace or while they are on the clock but off the premises. Although small businesses are least likely to be able to cope with the ensuing expenses, they are the ones that are hit the hardest each year by workers’ compensation claims.

It is important for every small business owner to evaluate his or her plan to stay protected from workers’ compensation fraud. There are several ways to detect it, and these five signs are some of the most common indicators.

1. Injury Time Look for accident reports that are filed on Monday and especially during the morning hours. When people injure themselves away from work during the weekend, they may come to work on Monday and fake an injury. It is important to ask other employees how the injured worker was acting immediately prior to the alleged incident. If they noticed signs of injury before that point, it is likely the employee is trying to commit fraud.

2. Lack Of Witnesses In many cases of workers’ compensation fraud, there are few or no witnesses. An employee will usually pick a moment when nobody else is around for the time of the non-existent accident. This can be hard to determine if the employee is alone often, but if he or she is rarely alone, this is a big red flag.

3. Repeat Claims More than 35 percent of workers who file claims also file other claims after that. These can trigger fraud alerts, but they should also serve as warnings to business owners to examine their operations and workplaces. If the conditions that caused an initial injury have not changed, it is very likely for another injury to occur. Employers in such situations will have a difficult time making a strong legal case.

4. Motive This is an important consideration for every employer. If the worker had a possible motive to claim a fake injury, it is important to address that. This could be a notice for dismissal, a raise being withheld or any other variety of reasons that made a worker upset.

5. Inconsistency And Body Language It is common for people who are being dishonest to show it in their body language. Long pauses before answers, shifty eyes and excessive fidgeting are common behaviors when people are telling lies. Listen carefully for any inconsistencies in a worker’s story about an accident, and look closely at the documentation to make sure the stories match. Clear evidence is needed to make a solid case in court, and instincts alone will not cut it.

Whenever a workers’ compensation fraud case has been clearly documented, it is important to report it to the workers’ compensation fraud investigation department in the state of residence. The Department of Labor provides information about this for every state. The best way to avoid workers’ compensation claims and fraud is to provide a safe workplace. When workers voice their concerns about any working conditions, it is important to take the necessary steps to remedy any problems. By keeping the workplace safe and making safety a top priority, employers can help their workers avoid injuries and show them that their health and safety are important to them.


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