Suspicious workers comp claims

by owner

Category: Blog

When you own your own business, you probably know the daily operations like the back of your hand. When anything goes awry, you are on top of it quickly to make sure things can get back to business as usual. So when one of your employees gets injured on the job, you want to be sure he can get better and get back to work as soon as possible. But what happens when you suspect that employee of falsely making a workers comp claim?

Insurance fraud is a serious problem here in the United States. With nearly $80 billion in fraudulent claims made each year (according to the Coalition Against Insurance Fraud), it is easy to understand why insurance premiums are on the rise. Preventing fraudulent insurance activity can help keep insurance costs down.

If you notice more than one of the following red flags, be sure to let your insurance carrier know that you suspect fraudulent activity:

  • Notice the date and time of the injury. Was it right before your employee was about to start for the week or right after he finished his last shift before the weekend?
  • Does the claim coincide with any other major events that may be coming up? Strike? Layoff? End of a season?
  • Do the doctors or legal consultants used by your employee have a history of suspicious claim activity? Do you notice their names on several different claims made by other employees?
  • Are you having a hard time finding witnesses that could back your employee’s story about his accident?

There are other things about claims that can cause you to question their validity. If you are suspicious of any claims, you can always contact us to find out what your carrier’s process is for reporting your suspicions. Just give us a call at (626) 967-9581.


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