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Warning Signs of Workers Compensation Fraud

Industry experts estimate the cost of insurance fraud to Americans in the neighborhood of $80 Billion….a striking estimate.  When reviewing your workers compensation injury claims keep the following warning signs in mind.  Where there is smoke….there may be fire.

1. Current Circumstances – Was there a decline in productivity prior to an employee’s work comp claim?  Have they experienced personal or financial issues?  Is there a reason for the employee to falsely claim an injury?  If an employee is dissatisfied in some way or might perceive their upcoming dismissal, either could provide a motive for faking an injury.

2. The Time of Injury  – Couple things to consider here.  Were there signs of injury that other employees witnessed prior to the ‘reported injury time’.  Did they struggle with or complain about routine duties prior to the alleged injury?  If accident was reported on a Monday it’s possible the injury occurred on personal time over the weekend.  Gaining witness accounts prior to the accident can help in identifying the true story.  Important that all questions and investigation be conducted in a ‘gathering details to protect and support the claim’ type of attitude.

3. Body Language – A quick phone call to an investigation company can really be of assistance here.  Before conducting a full interview of the claimant check with an experienced investigator.  They won’t charge you for a little advice.  Most of them want to be of help and are actually pleased to be asked for their experience.  Explain the claim and that you will be interviewing the subject.  Quality investigators have been trained in Kinesthetic interviewing techniques.  There are various indicators that a person is being dishonest.  A brief conversation will aid you in asking the right questions and documenting the words and body language the subject offers.  Critical to document what you see and hear.   This could head the list as the most important sign in determining the real from the fake.

4. Multiple Claims –  People do get hurt and many will work hurt so as not to lose hours or possibly their job.  Repeat claims do not always signal fraud.  However, it certainly would prompt you to seek further investigation.  Follow the three signs above in determining the validity of the claim.

Sending the message that ‘we take safety in the workplace as a top priority and we investigate fully every workers compensation claim to make sure our employees are protected’ will go a long way in creating an environment where employees won’t even consider making a false claim.

This entry was posted on Monday, July 28th, 2014 at 4:50 PM and is filed under blog, Featured, News & Information, Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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