Workers' compensation fraud
SFM works to eliminate fraud and welcomes your tips

Special Investigations Unit
The Special Investigations Unit expands SFM's efforts to eliminate workers' compensation fraud. It also combines SFM's active pursuit of fraud with other monetary recovery efforts such as subrogation in motor vehicle accidents and product liability.

The Special Investigations Unit is led by attorney MaryAnn Larson, whose experience includes work as a special claims investigator. The unit brings key staff together to resolve questionable claims with fraud indicators. This includes in-house attorneys, claims technical specialists, underwriting technical specialists, fraud specialists and claims representatives.

Tuned to the red flags indicating fraud, the unit develops a well-defined strategy for uncovering the facts and building a legal case. That might include, for instance, conducting surveillance, interviewing witnesses and checking public records for other leads. The unit addresses legitimate tips head on.

What you can do when you suspect fraud
The point person within your organization responsible for coordinating the administrative aspects of workers' compensation--your claims coordinator--may be in a position to recognize "warning signs" suggesting someone is trying to commit fraud.

Perhaps you've heard rumors from co-workers that the injury didn't happen at
work, or you witnessed something that didn't seem to add up. Here are some rules of thumb
to follow when you suspect workers' compensation fraud.

• Dig deeper to get to the bottom of the situation. Ask the employee questions if you've heard him talk about having a second job, or you've heard co-workers mention the employee's second job or contact-sport hobbies. However, rumors are sometimes motivated by ill will, so
  be straightforward in addressing and treating all employees fairly. Our
  common goal as employer and insurer
  is to identify and act on fraud issues
  that are real.
• Talk to anyone who may have witnessed the injury to get another account of the incident, or to any co-workers whom
  you think the claimant may confide in.
• Pass along whatever suspicions and information you've gathered to SFM
  when completing the online First Report
  of Injury. You can type your comments
  in the "Confidential comments" section. That way, the confidential information doesn't become part of the First Report, which the employee is entitled to receive
  by law. If you're reporting the injury on the paper First Report, simply attach a separate piece of paper to the form explaining your suspicions. A member
  of SFM's Special Investigations Unit or
  the claims representative will follow up
  with you.

If, after you've submitted the First Report, you come across information that makes you suspect fraud, call or email SFM's Special Investigations Unit or call your SFM claims representative.

Related info:

• Warning signs of fraud
• What is fraud?
• Zero tolerance practices
• Five steps to preventing fraud