Q. We've had a number of suspicious injuries at work this year. We don't want to jump to conclusions, but how can we determine if these injuries are part of a workers' comp insurance fraud scheme? —K.H., Mississippi
A. Many red flags can alert you that you're being victimized by workers' compensation fraud. Some things to watch out for:
- The worker changes physicians frequently or when a release to return to work has been issued.
- The worker seems unusually familiar with workers' comp claims-handling procedures and laws.
- A tip reveals that a “totally disabled” worker is employed elsewhere.
- The injured worker is never home when you call or stop by.
- The attorney demand letter is dated the day of the accident.
- The accident is not witnessed.
Any one or two of these hints, by themselves, may not raise your suspicion. However, if you see a pattern emerging, don't be afraid to investigate further or forward your suspicion to the appropriate authority. Your workers' comp insurer also may be able to suggest policies and practices to help prevent fraud and abuse.