Are You Being Taken? Top Signs of Workers’ Comp Fraud

Even if fraudulent claims are few and far between, they can raise your costs by impacting your MOD factor and premiums. Another impact? They can make it more difficult for legitimate claimants to cllect benefits because of increased anti-fraud measures implemented by insurance companies.

The National Insurance Crime Bureau’s list of red flags can help you spot fraud before it affects your bottom line.

Potential indicators of workers’ compensation fraud:

  1. Claimant is disgruntled, soon to retire, or facing imminent firing or layoff.
  2. Employee is involved in seasonal work that’s about to end.
  3. Employee took unexplained or excessive time off prior to injury.
  4. Employee takes more time off than the claimed injury seems to warrant.
  5. Employee is nomadic and has a history of short-term employment.
  6. Employee is new on the job.
  7. Employee changes physician when a release for work has been issued.
  8. Employee has a history of reporting subjective injuries.
  9. Review of a rehab report describes the employee as being muscular, well-tanned, with calloused hands and with grease under the fingernails.
  10. First notification of injury or claims is made after the employee is terminated or laid off.
  11. Has several other family members also receiving workers’ compensation benefits.
  12. Demands quick settlement decisions.
  13. Demands quick payments for medical providers.
  14. Claimant is unusually familiar with workers’ compensation claim handling procedures and laws.
  15. Claimant is consistently uncooperative.
  16. Employee refuses to allow visits or rehabilitation at home or specifies plenty of warning time prior to a visit.
  17. Employee participates in contact sports or physically demanding hobbies.
  18. After injury, the employee is never home or spouse/relative answering the phone states the employee “just stepped out” or may have to contact him by text or pager.
  19. Return calls to residence have strange or unexpected background noises, which indicate it may not be a residence.
  20. Employee protests about returning to work and never seems to improve.
  21. Employee cancels or fails to keep appointments, or refuses a diagnostic procedure to confirm an injury.

If you suspect fraud, please call MADSIF’ claims management partner, MAXCIS at 800-930-7272. If possible, please provide the dealership name; details and evidence of the suspected fraudulent claim and the name of the fraudulent claimant.