Workers’ compensation insurance fraud is an unfortunate but still common occurrence in the construction industry. Fraudulent claims increase insurance rates and put additional strain on already-struggling construction firms. While legitimate claims should always be filed and paid according the state and federal requirements, spotting fraudulent claims can help protect your business and reduce expensive insurance rate hikes.
Here are a few red flags that may prompt further review of a worker’s comp claim.
- Worker filing the claim is never home or available by telephone
- The claim coincides with a layoff, termination, plant closing, etc.
- Claimant is known to be active in sports
- The person filing the claim has another job
- The person filing the claim is in line for early retirement
- Worker receives mail at a P.O. Box and refuses to divulge their home address
- The person appears to have made a full recovery
- The worker is known to have skills that could be used to work on a cash basis while feigning a disability
- There were no witnesses to the accident in question
- The claimant has relocated out of state or out of the country
- Demands for compensation are excessive
- The person has a history of filing claims
- Doctors’ notes are contradictory
- Long-term disabilities claimed from soft tissue injuries
- The injury in question occurred during hunting season
Red flags merit further investigation, not immediate denial of a claim. Completely legitimate claims often display one or more of these conditions. A thorough review through proper legal channels should confirm or deny the validity of a claim, and protect your workers and business from the fallout of fraud or failure to pay.