Catch Them in the Act: Worker’s Compensation Fraud


Workers compensation fraud hurts everyone, as it raises rates for employers and it sets much stricter standards and a long process for claimants. Many worker’s compensation claims are valid, but there are always a handful in the bunch that try to sneak around the system.

Worker’s compensation fraud is a serious and common crime. When the fraudulent claim is approved, the so-called injured employee receives pay and benefits that they would not otherwise be entitled to. Below are some red flags to help you detect a possible fraudulent workers comp claim.

No Treatment Sought or Refusal of Treatment

If an employee flat out refuses to seek treatment for their injury, there may be a reason behind it and this should throw up a red flag. You should also be concerned when an employee never follows through with treatment or never goes for treatment.

Change in the Scope of Work or Job

If an employee who was just injured was recently reprimanded, a change occurred causing them to work less hours, or a project ended, you want to thoroughly investigate any claim of injury. Some employees will retaliate against their employer because of the change in job or hours hoping to receive benefits for an injury when one did not really occur.

Multiple Claims

Another thing you want to keep an eye on is how many times an employee has reported an injury or their claims history with their previous employers. If you notice a pattern of injuries or you believe there is enough evidence to prove they may be committing fraud, speak with authorities right away.

In addition to multiple claims, if an employee switches jobs frequently with no explanations or in a short amount of time, you should check into it.

Story Inconsistencies

When an employee cannot get their story straight and there were no witnesses who saw the accident happen, there may be a problem. Often, employees who plan to fake an injury will do so when no one else is around for obvious reasons. Over time, the employee’s story will begin to change or they may forget certain aspects of the story that they should have no problem remembering.

Employee’s Medical History

If one of your employees is known for having a pre-existing medical condition such as a back injury and then they slip and fall causing a back injury, you should be suspicious as to the extent of the pre-existing condition and the new injuries.

Always Check Out Stories and Hire Counsel

If you are unsure whether to believe an employee’s claim, seek legal counsel and speak with the local authorities. Your attorney can help represent you and prove the false claim. You should always investigate any injury claim by an employee, especially if it seems suspicious. Worker’s compensation fraud is one of the common types of fraud committed in the workplace and needs to be identified and stopped before you begin making payouts.

Bighorn Staff

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