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Workers’ Compensation Fraud – 5 Signs Your Company Is A Victim

July 5, 2016 by  
Filed under Blog

Every year, false insurance claims cost the United States billions of dollars. People are submitting false insurance claims in an effort to be financially compensated for something that is not deserved. It has been estimated that insurance fraud is one of the most menacing and expensive white collar crime, second only to tax evasion. One such insurance fraud is workers’ compensation fraud.

1 out of every 4 insurance fraud claims in the United States is related to workers’ compensation, reaching total of $7 billion in costs. According to the National Insurance Crime Bureau, each year, employees of all organization sizes report personal injuries that actually took place outside of their workplace. In other extreme cases, employees feign injury or other mental ailment just to gain financial benefits. The result is small businesses suffering by falling victim to this fraud only because they do not have the resources to investigate the insurance claim.

Is your business a victim of workers’ compensation fraud? Here are 5 signs:

1.     Monday Morning Injuries

The alleged injury takes placed first thing on Monday morning. If your employee files for personal injury early on Monday, chances are that the accident could’ve occurred during the weekend. Ask employees to provide an account of what they observed, how the allegedly injured employee came about to get hurt; did they seem injured prior to the account? If so, this could be a red flag pointing to fraud.

2.     Lack of Witnesses

It is common enough for employees who are looking to commit fraud to choose a specific moment when they are alone – and hence, unobserved – to stage the accident. While it is completely normal for the accident to occur without anyone nearby, look at the conditions under which the employee was alone. Is the venue of the injury often secluded? Was there any reason for the employee to be there? Is the employee’s job designed in a way where he or she must be alone?

3.     There’s an Employment Contractual Change Just around the Corner

In some cases, the employee may feign an injury when there is an imminent contractual change that is about to be put into effect. This could be in form of a layoff, downsizing, end of a project, or the conclusion of seasonal work.

4.     Conflicting Reports & Claims

When one concocts a lie, inconsistencies surface over time. During one investigation, they might claim one thing; next time, the statement may change or vary. Furthermore the employee’s description of the accident may not seem cohesive with their medical history and past records.

5.     Repeat Claims

This is one of the most obvious red signals that one cannot miss. According to a study by the NCBI, 37 percent of workers who file a workers’ compensation claim also file a subsequent one. We mustn’t, of course, overlook the possibility that the claim could indeed be authentic, however, the statistics claim that an extensive investigation is warranted under these conditions.

While these are signs that your company might be subjected to fraud, further investigation and evidence is required to prove your case. Today, private investigation firms have evolved as expert corporate investigators, offering a wide area of expertise and services at affordable fees. Get in touch with a professional private investigation firm that offers you numerous investigative solutions to eliminate this threat.

Contact Experienced & Licensed Private Investigators For Your Investigations!

National SIU is one of the most trusted names in the private investigation industry. With a huge network of investigative experts and field staff, the company has been delivering high quality services to both national and international clients. Having expertise in various fields, the company is currently providing services to both private and corporate clients.

For more on insurance fraud investigations, visit their website, or contact them on their toll free number 800-960-NSIU (6748).


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