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.

  1. Claimant is never home to answer the phone or is “sleeping and cannot be disturbed.”
  2. Injury coincides with layoffs or a plant closing.
  3. Leads from co-workers suggest that your subject is active in sports or other activities.
  4. Rehab reports indicate a healthy-looking claimant.
  5. No organic basis for disability. All indications are that the subject has made a full recovery.
  6. Claimant receives mail at a post office box and will not divulge the actual address of his/her residence.
  7. 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.
  8. Claimant has moved out of state or country.
  9. Excessive demands for compensation.
  10. Disability beyond that normally associated with claimed injury.
  11. Claimant has a history of malingering.
  12. “Dueling Doctors.” One says the claimant is disabled, the other says no.

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