After filing a workers’ compensation insurance claim for a shoulder injury he sustained while working for the federal postal service, the recipient of the benefits was seen working as a massage therapist. This leads to felony charges related to fraud.

An ‘injured’ entertainer was seen dancing in a popular television commercial while collecting a fifty thousand dollar surplus in workers’ compensation payments related to a previous disability claim.

After filing a workers’ compensation claim about an injury sustained while on the police force and collecting more than $ 30,000 in benefits for it, it was discovered that the former officer was working for a musical band, something he would not have been able to do. physically. if your injury claim was actually true.

If you really dig into it, you will find more and more strange stories about workers’ compensation fraud. Fortunately, the proportion of these is quite small in contrast to the valid ones. For the small business owner and large commercial enterprises, it is vital to be aware of how to detect system abuse.

5 ways to understand workers’ compensation fraud

1. Something may not be right when a worker files a workers’ compensation claim for an injury that allegedly occurred seven or more days previously.

Here’s what to do if this happens. Talk to the injured worker as well as your co-workers to gather information about the incident and draw your theory to a conclusion.

2. A workers’ compensation claim that was filed immediately after the weekend may indicate that the injury occurred outside of the workplace.

Here’s what to do if this happens. Find out if the worker has interests in hobbies or sports activities that may have triggered the injury. Conduct interviews with other employees to see if they have any knowledge about whether the claimant participated in this type of weekend activity. Keep your eyes open for verbal or body language that shows the worker is lying.

3. The absence of witnesses to the injury could mean that the claimant is not genuine.

This is what you can do in this case. Make the appropriate inquiries with others if someone saw the claimant immediately after the injury.

4. What if the claimant wishes to be treated without undergoing an X-ray, MRI, or other tests that define the injury?

Here is what you can do in this situation. Ask the claimant why they are not interested in a documented diagnosis. Demand that you undergo the necessary diagnostic tests.

5. Any claimant who does not provide a clear picture of what happened when he was injured is subject to suspicion.

This is what to do in this scenario. Take all the details of the report using your knowledge of the usual state of affairs on your business site. Watch for any inconsistencies in your account.

If your findings regarding the above points do not justify the claimant, feel free to take your thoughts to the claims department of your insurance company.