Fraud: These are some “Red Flag” indicators to be aware of.

Everyone plays a role in combating fraud.  Being aware of some “red flags” will help prompt additional questions and/or investigations into these issues. 

• Accident occurs on a Monday morning or late on a Friday and is not reported until the following Monday.  What occurred over the weekend or during days off?

• The accident occurs just prior to a strike, plant closing, layoff, job termination or end of seasonal work..

• Accident was unwitnessed by any fellow employees.

• Injured worker has a history of prior claims.

• Substantial delay between date of incident and date reported to supervisor.

• Different descriptions between employer’s accident investigation and medical provider’s report.

• Difficulties reaching injured worker at home during disability period.

• Injured worker’s attorney or medical provider is known for being involved in suspect claims.

• Injured worker switches medical providers frequently.

• After receiving a release to return to work, injured worker switches physicians.

• Injuries are minor (strain/sprain), but requires excessive treatment and lost time.

• Date of services do not correlate with the date of injury.

• Injured workers from the same insured are all using the same medical provider or attorney.