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.