Warning Signs of Worker's Compensation & F.E.L.A. Fraud
You may not discriminate against a worker who has filed previous workers’ compensation claims. However, when you have several of the following suspect behaviors present or you observe an emerging pattern, don’t be afraid to investigate further for possible fraud or to forward your suspicions to the appropriate authority.
About the worker
The injured worker has an unstable work history; i.e., an employee who often changes jobs.
The claimant has a history of reporting subjective injuries which may include workers’ compensation or liability claims.
The claimant is consistently uncooperative.
The injured worker has been recently terminated, demoted, or passed over for a promotion.
The injured worker is in line for early retirement.
The injured worker is making excessive demands.
The injured worker calls soon after the injury and presses for a quick settlement of the case.
The injured worker moves out of state soon after the injury.
The injured worker changes his or her address to a post office box or receives mail via a friend or relative.
About the workplace
The injured worker’s workplace is experiencing labor difficulties.
The accident occurs just prior to job termination, layoff, after formal discipline of the employee, or near the end of the employee’s probationary period.
About the injury
The injured worker was not injured in the presence of witnesses.
The injury is a subjective one, like stress, emotional trauma, or is hard to prove, like back pain, headache, insomnia, etc.
The accident is not promptly reported by the employee to the employer.
The employers’ first notice of the injury is from an attorney or a medical clinic, and not from the injured worker.
Physicians who have examined the injured worker have vastly differing opinions regarding the injured worker’s disability.
There is no sound medical basis for the disability; all physicians’ reports indicate a full recovery.
The injured worker is claiming disability exceeding that which is normally consistent with such an injury.
The accident occurs late Friday afternoon or shortly after the employee reports to work on Monday.
The claimant has the accident at an odd time, such as at lunch hour.
The accident occurs in an area where the injured employee would not normally be.
The task that caused the accident is not the type that the employee should be involved in; i.e., an office worker who is lifting heavy objects on a loading dock.
The details of the accident are vague or contradictory
About the medical relationship.
The claimant frequently changes physicians or medical providers.
The claimant changes physicians when a release for work has been issued.
A review of medical reports provides information that is inconsistent with the appearance or behavior of an injured person; i.e., a rehabilitation report describes the claimant as being muscular, with callused hands and grease under the fingernails.
The employer’s first report of injury contrasts with the description of the accident set forth in the medical history.
The injured worker develops a pattern of missing physician’s appointments.