Fraud Red Flags
While the majority of workers’ compensation claims are legitimate, claims fraud is more common than you might think. The following is a list of red flags that may indicate a closer look at the claim is warranted.
- Claimant is never home to answer the phone or is “sleeping and cannot be disturbed.”
- Injury coincides with layoffs or a plant closing.
- Leads from co-workers suggest that your subject is active in sports or other activities.
- Rehab reports indicate a healthy-looking claimant.
- No organic basis for disability. All indications are that the subject has made a full recovery.
- Claimant receives mail at a post office box and will not divulge the actual address of his/her residence.
- Claimant has a history of self-employment and/or is a tradesman (e.g., carpenter or electrician) who might readily work for cash while feigning disability.
- Claimant has moved out of state or country.
- Excessive demands for compensation.
- Disability beyond that normally associated with claimed injury.
- Claimant has a history of malingering.
- “Dueling Doctors.” One says the claimant is disabled, the other says no.
