WorkComp Advisory
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Red Flag Fraud Checklist

While fraud represents a small percentage of workers’ compensation claims, it is important to recognize “red flags” or indicators of the need for further investigation to determine the legitimacy of the claim. The existence of one or even several of these indicators is not necessarily indicative of the existence of Workers’ Compensation fraud; however it is important that you inform your Advisor so that the proper investigation can be undertaken:

• Inexplicable reporting delay
• No witness to alleged injury
• Insufficient detail about injury/accident
• Injured worker is a new employee
• Injury is inconceivable for worker’s job
• Injury is not visible (e.g. soft tissue injury)
• Allegations or rumor of fraud
• Injury reported after days off
• Impending layoff of injured worker
• Inconsistencies in description of claim
• Injured worker has no health insurance
• Injured worker has personal financial problems
• Injured worker exhausted sick/vacation days
• Injured worker is physically active outside
• Injured worker submitted past Workers’ Comp claims
• Frequently unable to contact injured worker off work
• Injured worker hires attorney quickly or with questionable reputation
• Degree of injury unlikely from accident
• Injured worker changes care providers frequently
• Injured worker has indemnity checks mailed to his home
• Later medical evaluation contradicts initial one
• Injured worker missed scheduled medical appointments