How to Spot Workers' Comp Fraud

Topics: Workers' Compensation

Did you know that one in 10 small businesses is worried that an employee on its team will fake an injury and commit workers’ comp fraud? In a recent article for Property Casualty 360˚, AmTrust’s resident workers’ compensation expert outlined six signs of a false workers’ compensation claim. Thankfully, he also offers several ways to spot the fake claim.

Is Your Employee Faking a Workers’ Comp Injury?

Here are six signs of a potentially fraudulent workers’ compensation claim, according to AmTrust Workers’ Compensation Insurance Product Manager, Matt Zender:

  1. You’ve heard employees gossip about the employee’s injury.
  2. You can’t get a clear idea of what actually happened from those involved.
  3. The injured party is refusing diagnostic procedures like an X-Ray or MRI.
  4. There aren’t any witnesses to the injury event.
  5. The claim is reported on a Monday morning.
  6. The claim is reported more than seven days after the injury occurred.

Individually, these signs do not conclusively mean a workers’ comp injury is false, but when more than three  of them are present, it might be time to take a closer look at the situation and the employee’s claim. Workers’ compensation claims are expensive both at the time of injury and over the long run. However, there are ways to help mitigate the costs of a workers’ compensation claim – check out “Help Your Agency Clients Create a Win-Win Return-to-Work Program.”

How to Handle Workers’ Compensation Claims

As an employer, it’s not unusual to be skeptical of a false workers’ compensation claim and see some as a neon “STOP” sign every time an employee is injured on the job. But consider these facts before thinking the worst of your employees:

  • New employees are three times more likely to be injured on the job than seasoned and experienced team members. At the same time, it’s important to consider the employee’s age, experience, and job training while considering whether a workers’ compensation claim is legitimate.

How to Report Workers’ Comp Fraud

If one of your employees has made a fraudulent workers’ compensation claim, it’s important to understand and follow the proper procedure to ensure that your business is protected. If you feel one of your employees is taking advantage of your workers’ compensation coverage after investigating the incident, report your findings to your claims adjuster. Armed with the facts and specifics, this professional will be able to take care of everything quickly and with minimal disruption to your business.

Learn more about Workers’ Compensation Insurance for small and mid-sized businesses and find out in our AmTrust Blog post, “Is Workers’ Compensation Mandated?

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