Workers’ Comp Basics

Fraud

In 2007, Summit investigated more than 200 suspected workers’ compensation fraud cases which resulted in an estimated $5.6 million in claims savings and in excess of $1.5 million in actual premium recovery. Here are some common red flags that may help detect fraud—

  • Injury was not reported promptly to a supervisor.
  • No one witnessed the accident.
  • Task that caused the injury is not consistent with job duties.
  • Injury occurred late on Friday or early on Monday.
  • Employee had been recently reprimanded, put on probation or laid off.
  • Alleged injury coincides with personal problems.
  • Employee immediately hires an attorney.
  • Injured worker is familiar with claim procedures and workers' compensation law.
  • Employee changes physicians when a release for work has been issued.
  • Letter from injured worker's attorney is dated the day of the reported accident.
  • Attorney threatens legal action unless a quick settlement is reached.
  • Inappropriate and expensive treatment is prescribed for minor injury.
  • Documentation doesn't support services listed on medical bills.

For more details on workers’ compensation fraud and how to prevent it, check out our CompEssentials brochure.