Warning Signs of Claimant Fraud

1. Monday Morning: 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. Suspicious Providers: An employee’s medical providers or legal consultants have a history of handling suspicious claims, or the same doctors and lawyers are used by groups of claimants.

4. No Witnesses: There are no witnesses to the accident and the employee’s own description does not logically support the cause of the injury.

5. Conflicting Descriptions: The employee’s description of the accident conflicts with the medical history or First Report of Injury.

6. Claim History: The claimant has a history of a number of suspicious or litigated claims.

7. Treatment Refused: The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.

8. Late Reporting: The employee delays reporting the claim without a reasonable explanation.

9. Hard to Reach Claimant: The allegedly disabled claimant is hard to reach at home.

10. Changes: The claimant has a history of frequently changing physicians, changing addresses and numerous past employment changes.

Note: Although the presence of two or more of the above factors may indicate a fraudulent claim, the factors are simply indicators. Many perfectly legitimate claims are filed on Mondays –and some accidents have no witnesses.

Source: EMPLOYERS

Topics Fraud