Warning signs of fraud

Watch for these warning signs. Especially in combination, they are the most typical characteristics of fraudulent claims, although legitimate claims sometimes have them, too.

The employee:

• Is disgruntled
• Is soon to retire, faces termination or layoff, or is near the end of seasonal work
• Has been employed by your organization less than one year
• Waited a long time before claiming the injury
• Waited until after termination or layoff to claim the injury
• Took time off prior to claimed injury
• Has a history of short-term or unstable employment
• Has a history of alcohol or drug abuse
• Has other family members who receive workers' compensation or unemployment benefits
• Has filed numerous claims over the years
• Is unusually familiar with workers' compensation procedures and laws
• Is hard to reach at home, or the spouse always calls in
• Changes medical providers after he or she is released to return to work

The injury:

• Occurred late Friday or early Monday
• Occurred just before or after a holiday
• Was not witnessed
• Occurred in an area where the employee normally would not be
• Is vague or the details are contradictory
• Is rumored to have never really occurred or to have occurred off work

Related info:

• The Special Investgations Unit
• What is fraud?
• Zero tolerance practices
• Five steps to preventing fraud