According to the Bureau of Labor Statistics, nearly 3 million employer-reported non-fatal workplace injuries and illnesses occurred in 2012. Although that is a decrease over previous years, it still shows that workers are injured on the job every day across the country. Unfortunately, while some of these injuries can be serious, there are some workers who may view a minor injury as a lottery ticket, and will try to milk that injury for all it's worth through workers' compensation fraud. Luckily, there are many ways to identify possible workers' compensation fraud, and things to watch for as red flags if an employee is injured on the job.
Workplace injury can happen at any time without warning. However, if an accident is reported as happening very early in the morning, and especially at the beginning of the week, it is possible that the injury actually occurred the evening before or over the weekend, and may be sports-related or associated with an outside activity, but the employee is attempting to claim the injury as workplace-related.
If the injury occurred in an area where the employee shouldn't normally be, such as a high-risk area that is normally off-limits to some employees, or if there was no witness to the injury, this could be an indicator of workers' compensation fraud.
Some employees may attempt to fake or exploit a workplace injury if they are facing financial pressures, or if they anticipate a disruption in pay or employment due to projected layoffs, predicting worker strikes, or temporary furloughs.
A history of short-term employment is not always a predictor of fraud or misuse, but when combined with a suspect situation could be a sign of prior potential fraud. If it is discovered that the employee lied on their original job application, this could be an indicator that they wanted to hide a previous workers' compensation issue.
In cases of serious injury, it is not uncommon for an individual to visit different specialist physicians. However, if during the course of treatment the individual changes their primary care provider several times, it could be an indication that they are looking for a more favorable diagnosis of their injury.
It is expected that an employee will need time off work for recovery from an injury, but if they seem to be taking off more work days than the reported accident should warrant, this could be a sign of abuse.
Although it is everyone's right to retain legal representation in any incident, if the employee retains this legal representation immediately after the accident has occurred, it may be a signal that they are not willing to accept a reasonable outcome or may face difficulties in making a workers' compensation claim.
Here at Rock Security Enforcement Task Force, we approach every assignment with a clear and thorough investigative plan. We use every possible approach to investigate potential workers' compensation fraud, including surveillance with audio, video, and other methods to determine if the worker has actually suffered an injury, and if this injury impacts their daily activities as they have claimed.
We also conduct thorough interviews as part of our investigation, including interviews with colleagues, friends, family, and other individuals to determine if there may be an issue of fraud, if there appears to be an attempt to cover up potential fraud, and in the situation that fraud is suspected, to determine the degree of this fraud.
Using our vast resources and investigative capabilities, we will conduct background checks and records research, including medical records, employment records, and other records such as financial history or travel records. In many cases, fraud can be discovered and proven by a history of financial problems, vacations or activities that happen to coincide with absence from work due to an injury, or if the employee has filed numerous compensation claims in the past.
Our dedicated workers' compensation investigators can also gather evidence in the event that workers' compensation fraud is uncovered, helping employers or businesses in any legal prosecution, or in the event that workers' compensation must be cut off due to an illegitimate claim.