I just read the article “Ten Tips for Detecting Fraudulent Claims”, posted August 11, which warns workers and employers alike of the dangers of fraudulent claims made against workers’ compensation. The article revealed a disturbing trend among dishonest employees who try to file erroneous claims for compensation.
According to the article, this deceitful practice is causing insurance companies a lot of money, which is in turn passed onto the employer who will pay higher premium. If disregarded, this crime may affect the ability of the agency to further sustain its ability to pay other claims and workers’ benefits.
To detect fraud in claims processing and transaction, the article suggested looking at some following telltale signs:
- Lack of prompt reporting –when an employee does not immediately report an injury, it is best to review the employee’s record
- Unclear details – if an employee cannot recall or make a clear description of an accident, it is important to keep more attention to the progress of the report.
- No witness
- Discrepancy in story – during investigation, when a person keeps changing his story, it is good reason to suspect fraud.
- First day of the week claim
- Disgruntled employee
- Financial problem at home
- Employee never answers the phone (at home)
- Misses medical appointments
- Engages in activity inconsistent with the injury sustained
The above mentioned hints may be helpful in detecting fraud in compensation claims. The article is informative and useful for both employees and employers alike.