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Red Flags of Fraud

Use the Red Flags of Fraud Checklist (below) as a guideline when requesting an investigation from your insurance adjuster. Sometimes the claimant's behavior alone can warrant investigation. Here are some claimant behaviors that raise red flags:

  • Injury takes longer to heal than medical guidelines specify.
  • Injury is reported late, or reported to a lawyer or the state commission before being reported to the employer.
  • Fails to attend weekly meetings. 
  • Is uncooperative; won't try a transitional duty job. 
  • Is not home during the workday when you phone.
  • Only has a postal box, not a home address. 
  • Misses doctor appointments.
  • Performs seasonal activities, hobbies, or work.
  • Has moved out of town or out of state.
  • Disputes average weekly wage due to additional income. 
  • Files for benefits in state other than principle location. 
  • Disputes information supplied by the employer
  • Submits repetitive medical reports indicating continuing, constant pain with conservative medical treatment.
  • Refuses to cooperate in claim investigation. 
  • Has unstable work history. 
  • The insurance company wants to settle the claim for "big money."
  • The word "disproportionate" is used in medical reports.
  • Positive "Waddell Tests" or "facial grimacing" are mentioned in reports.
  • Things just do not add up. 

Reach out and communicate be the first to learn of a problem, and the first to propose a solution instead of a lawyer. 

What prevents the federalization of workers comp? Attorney Ted Ronca takes a look at the economic and political reasons for workers comp state laws.

E-Verify compares the information an employee provides against millions of government records and generally provides results in three to five seconds. Learn more. 

Is your claimant resting and healing or snowmobiling and ice fishing?  This could be a period of the year where surveillance is more needed in your company. Read it. 

If communication between the employee, employer, and physician is in place, it is much more likely the employee will return to work. Read.

What issues led to the preventable death of a young woman and what actions has the government taken to prevent this from happening again?

The book guides the user through each aspect of a workers' compensation program, to learn, step-by-step about a variety of techniques that show organizations exactly how to reduce workers comp costs. 

 "Understanding the Urgency for Reducing Unnecessary Medical Care and Costs" February 27-28, 2013 Cambridge, This problem is addressed in the context of the larger fiscal and political challenges faced in workers compensation.  
RIMS '13 will introduce new products, establish your presence in the marketplace, reinforce relationships with existing clients,
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SEAK is the sponsor of the largest and most highly regarded national workers' compensation and occupational medicine conference. SEAK's Workers' Compensation and Occupational Medicine Conference was first held in 1980 and takes place each July on Cape Cod. 
New summaries for "drug testing and workers compensation state laws" for every jurisdiction are NOW posted on our website. Click on the link above to check it out.
REDUCE WC COST 20% to 50%
Workers Compensation Management Program
Learn more about our book on
for employers.
Article Library

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Five Practical Ways to Reduce Medicare
Set Asides (MSA)

Lowering Workers Comp Costs for Employers

Rebecca Shafer, Attorney & Risk Consultant

Contact Us: Becki@ReduceYourWorkersComp.com

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