Fraud: These are some “Red Flag” indicators to be aware of.

Everyone plays a role in combating fraud. Being aware of some “red flags” will help prompt additional questions and/or investigations into these issues.

  • Accident occurs on a Monday morning or late on a Friday and is not reported until the following Monday. What occurred over the weekend or during days off?
  • The accident occurs just prior to a strike, plant closing, layoff, job termination or end of seasonal work..
  • Accident was unwitnessed by any fellow employees.
  • Injured worker has a history of prior claims.
  • Substantial delay between date of incident and date reported to supervisor.
  • Different descriptions between employer’s accident investigation and medical provider’s report.
  • Difficulties reaching injured worker at home during disability period.
  • Injured worker’s attorney or medical provider is known for being involved in suspect claims.
  • Injured worker switches medical providers frequently.
  • After receiving a release to return to work, injured worker switches physicians.
  • Injuries are minor (strain/sprain), but requires excessive treatment and lost time.
  • Date of services do not correlate with the date of injury.
  • Injured workers from the same insured are all using the same medical provider or attorney.

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