What are some key indicators of workers’ compensation fraud?

| May 30, 2019 | workers compensation insurance defense

“Blind faith can end up costing you.”

Although that warning is explicitly directed toward business employers in Louisiana and nationally, a recent in-depth media article on workers’ compensation fraud additionally underscores its relevance for the general public. That piece stresses the broad-based downside of workers’ comp-linked wrongdoing for insurers, consumers and taxpayers as well.

How big is the problem? Reportedly, and as we note in our May 23 blog post at the proven insurance defense law firm of Caffery, Oubre, Campbell & Garrison in Lafayette, outsized indeed. One estimate pegs the annual economic damage of workers’ comp fraud in the United States at about $7 billion.

Thus, the admonition – especially for employers – to routinely be on the close lookout for ruses aimed at bilking the system and unlawfully collecting accident/injury benefits linked with bogus claims.

The above-cited article points to several “red flags” that might reasonably trigger an employer’s suspicion that fraudulent behavior is being committed. Here are some representative indicators:

  • No third party can verify that a workplace accident or injury actually occurred
  • The claimant has a personnel file that points to a pattern of workers’ comp claims
  • There is an inexplicable lag between the time an injury allegedly occurred and its formal reporting
  • Claimant balks at medical treatment and diagnostic testing

Workers’ compensation fraud comprises multiple variants. Obviously, a claim might be altogether false; the alleged accident or injury simply never happened. It is sometimes the case, too, that a claimant materially exaggerates an incident. And while some workers do indeed suffer injuries, those might have occurred at home or some other venue outside the workplace.

Workers’ compensation fraud is broadly injurious to the public. An employer suspecting an attempt to cheat the system should immediately contact insurance company officials, who can benefit in turn from securing the close and studied input of experienced insurance defense attorneys.