Workman's Comp Claimant Fraud Warning Signs

Written by on 5/23/2016 3:47 AM in , , . It has 1 Comments.


Are you concerned you’re being deceived on a workman’s comp insurance claim? There is more than one way a dishonest employee may be working the system.

Seeking help
There are two types of workman’s comp insurance fraud. Claimant fraud can be either totally fraudulent or partially fraudulent. In either situation, the first place you should turn to handle the potentially fraudulent claim should be your producer – the individual or business that sold you your workman’s comp policy.

Investigation
In the event of suspected claimant fraud, timely reporting is integral to investigation. When you (the policy holder) suspect fraud, plan to contact your producer, the carrier’s claims department, as well as their special investigations/fraud investigations department.

Tell them you’ve seen these warning signs of fraud:

• Alleged injury reported Monday morning, but was alleged to have occurred late Friday afternoon.

• Reporting is delayed without reasonable explanation.

• Incident is reported just before an employment status change (strike, layoff, project ending/seasonal work).

• Claimant has a history of suspicious/litigated claims.

• Claimant’s medical/legal providers have history of suspicious claims.

• No witnesses or incident description does not logically support injury.

• Conflicting descriptions between employee, medical history, and/or first report.

• Claimant refuses diagnostic procedures to confirm injury.

• Allegedly disabled claimant cannot be reached.

• Claimant has a history of frequent physician, residence, and employment changes.

Premium protection
Every state allows the retroactive correction experience ratings in the event of a criminal claimant fraud conviction to protect your premium from being raised due to fraudulent claims. Your producer can assist you in removing it.

Protect yourself. Detect and prevent workman’s comp insurance fraud claims with the help of Minnesota Comp Advisor today.

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