Fraud Red Flags

There are numerous "Red Flags" that can raise suspicions regarding the validity of an alleged injury, claim or event.  While "Red Flags" can assist in evaluating a claim, only a THOROUGH INVESTIGATION can uncover all the facts.  Our job is to assist you in obtaining the facts.

 

Business owners should be knowledgeable as these "Red Flags" to avoid being struck with an unnecessary claim.  These are indicators, which by themselves certainly do not reveal that the claim is fraud, however when taken as a group, they will suggest further investigation into the accident.

 

Workers Compensation Claims

• Claimant is scheduled to retire or be laid off

• Claimant is disgruntled or recently received notice of suspension or termination

• Claimant is experiencing financial difficulties

• Claimant has a history of short term employment

• Claimant has only been on the job a short period of time

• Claimant is involved in "seasonal work" scheduled to end

• Claimant only has a beeper or cellular phone to be contacted at

• Claimant uses a post office box as his only address

• Co-workers believe that claimant was injured while engaged in a recreational activity

• Co-workers have recently seen the claimant engaging in activity inconsistent with an alleged injury or current medical restrictions

• Claimant's account of the accident is vague

• Alleged injury is not reported in a timely manner or not reported until after a job termination

• Facts described in the first report of injury are inconsistent with medical findings/examination

• Claimant comes up with new physical disabilities/symptoms when about to be placed at MMI

• Claimant recovery time is significantly longer than expected for the type of alleged injury reported

• Claimant purchased a disability policy shortly before the alleged injury

• Alleged injury occurs on a Monday morning

• Alleged injury occurs after being denied a request for vacation/personal time off

• Alleged accident is not witnessed

• Alleged injury occurs at an off time ( i.e., coffee break, lunch time)

• Alleged injury occurs in a work area not assigned to the claimant

• Alleged injury occurs while performing work not normally assigned to claimant

Staged Automobile Accidents

• Accident occurs between intersections, in the middle of the block

• The claimants car is reported to have stopped suddenly for no apparent reason

• Accident occurs in non-congested traffic conditions

• Claimants vehicle has multiple passengers

• All occupants in the claimants vehicle allege injury despite low impact/minimum vehicle damage

• Claimant's vehicle is an older model

• Victim's vehicle is a newer "high" price model

• Victim states that he became "boxed in" preventing any attempt to avoid the collision

• Claimant has prior history of claims or civil litigation for personal injury accidents

• Claimant can easily and quickly produce name, address and phone number of alleged witness(es)

• Claimant insists on being transported to the hospital via ambulance even when paramedics advise it is not medically necessary

• Claimant is seeing own medical specialist

• Claimant can produce a videotape of the accident or the events immediately following the accident from an "unknown" witness

• Claimant is well versed in claim filing procedures, terminology and paperwork

 

Fraud Committed By Employees Against The Company   Significant observed changes from past behavior patterns High personal debts or financial losses Inadequate income for lifestyle Extensive stock market or other speculation behavior Excessive gambling Undue family, company, or community expectations Excessive use of alcohol or drugs Perceived inequities in the organization Resentment of superiors and frustration with job Peer group pressures Undue desire for self-enrichment and personal gain Emotional trauma in home life or work life