Workers' compensation insurance is not only a legal requirement but is also a vital step to protect your employees from losing their income in the event of an injury. Unfortunately, this protection can sometimes be abused by individuals who aren't genuinely injured, raising your insurance premiums and taking the money that's supposed to be saved for a legitimately injured worker. If one of your employees is unscrupulous and desperate for funds, it's possible he or she may hit on the idea of exploiting the workers' compensation system by faking an injury. Use these three signs to help you identify possible instances of fraud.
1. Timing of report
A worker who commits workers' compensation fraud may decide to do so after being injured over the weekend. He or she will then come in to work on Monday and report an injury that supposedly occurred on Monday or else on the previous Friday, but that actually happened over the weekend. This is why injuries reported on Monday are immediately suspect. Other events that may induce a faked injury include a strike, a layoff or termination, or the end of a seasonal job. Employees in these situations occasionally find themselves strapped for cash and decide to try to get workers' compensation benefits out of the deal to help them cope.
2. Recent behavior
If the employee in question has recently seemed to have a negative attitude at work, indicating displeasure with the job or with management or co-workers, he or she may have some issue that could act as a motivation for fraud. This is especially the case if he or she seems sullen and resentful, blaming the problems on others, and refuses to personally take steps to resolve an issue (or only does so grudgingly). If you've been keeping tabs on your employees' behavior and attitudes, this can help you discern whether it's a case of an employee who just can't get a break (getting an injury at a job you're unhappy with is really no fun) or an employee who's using dissatisfaction as a justification for fraud.
3. Suspicious story
If an employee wasn't genuinely injured at work, the true story won't do, so an alternate story will be presented for the origin of the injury. You should be suspicious if the story has small inconsistencies and the injury wasn't witnessed by any co-workers, especially if the employee normally has several co-workers nearby. An inconsistent story, though, should be distinguished from a story that's not smoothly told. Remember, if the story is long and sounds well-rehearsed, it may be just that. Look for small factual inaccuracies. An even bigger tell is when the story doesn't seem to match the medical opinion of how the injury may have occurred.
Remember, not all of these signs may be immediately evident in each case of fraud. On the other hand, one or more signs may appear to be present even in a legitimate case of work injury. Use these signs as a general guideline to help you discern when to investigate further into the situation, and remember to locate a competent workers compensation attorney to help you navigate the legal issues that develop when you suspect fraud.Share