06/ 01/ 2005
by Jennifer Strong
Workers’ compensation insurance gives a whole new definition of pain for employers. You hate for your employees to get hurt on the job; you don’t like being without them while they recover; and you detest dealing with unscrupulous people who try to work the system.
Workers’ comp is one of the most talked about types of insurance, and with good reason: It is one of the most expensive. One of the reasons for the high price tag is the persistent problem of fraud. Insurance companies fight back with increased premiums, which affect everybody.
“There are three common types of workers’ comp fraud: injured worker claim fraud, health-care provider fraud and employer fraud,” says Jeremy Jackson of Ohio’s Bureau of Workers’ Compensation. For the most part, injured worker claim fraud is the easiest of the three to spot, Jackson says. And recognizing the red flags can help owners stave off potential fraud and bring current fraud to a halt.
Here are some common signs an employee isn’t being truthful about his workers’ comp claim:
1. The injured worker is never home or accessible, even by phone; they are considered hard to track down.
2. The injured worker refuses, delays or simply misses appointments for the diagnosis of the injury itself.
3. The injured worker does not recall specific details of the injury, or even how the injury actually occurred.
4. The injured worker has noticeable signs, such as calluses on his hands, that may signify he is working somewhere else while he is absent from your business on workers’ comp.
5. The injured worker was either a new employee or a disgruntled employee before the claim occurred.
Though not any one of the red flags confirms a case of fraud, they can be used as a guide. If more than one red flag is present, chances are that fraud may be occurring, and corrective steps need to be taken.
Fraud Stoppers
Protect yourself from faulty claims
One of the best measures an employer can take in preventing fraud is to be prepared, says Richard Owens, of the Insurance Fraud Unit for the state of Connecticut. He recommends employers:
> Always check employee references carefully.
> Train staff to handle the reporting of workplace injuries.
> Post the fraud hotline number for the insurance company.
> Take safety complaints and concerns seriously, and correct any problems.
> Make workers’ comp a part of overall training, thus educating employees about the seriousness of the issue.
Web Extras: Find even more red flags in the “Web Extras” section of http://www.NFIB.com/toolsandtips.
