Avoiding Workers Compensation Fraud

The following is a list of red flags to look for in potential workers compensation fraud:

Employee Red Flags

– Is seldom available at home

– Delays return to work after maximum medical improvement

– Refuses light duty opportunities

– Is vague or contradictory about how the injury occurred

– Was in jeopardy of termination or probation prior to injury

– “Shops” for a provider and/or is noncompliant with treatment

– Conceals pre-existing medical information relevant to the claim

– Delays reporting the injury

– There is evidence that the employee has other concealed employment and/or is participating in activity that is contradictory to reported physical limitations

– There is no witness to the injury nor resulting symptoms

Employer Red Flags

– Fabricates location or type of operation

– Under reports payroll

– Medical Provider Red Flags

– Bills for services not actually rendered

– Bills for products not actually provided

– Over bills

– Fabricates procedures

– Unbundles services