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Workers’ compensation is a means to ensure that employees are financially protected in the event that the performance of their duties at work puts them in harm’s way. Unlike a personal injury claim, a workers’ compensation claim is not meant to determine fault, but rather it determines whether a claimant is entitled to compensation (which the employer is obliged to pay).
Obviously, nobody wants to pay for something that they shouldn’t, and there are times when workers file false workers’ compensation claims in order to benefit financially by faking a job-related injury or illness.
Tips to Protect Your Business From Workers Compensation Fraud
Perhaps the most common misconception about workers’ compensation fraud is that it is common. The truth is that only 1% to 2% of all workers’ compensation claims are false. However, even when it rarely happens, workers compensation fraud costs employers about $30 billion per year. With this in mind, what are some signs that an employee may be committing fraud?
Refusal to Undergo a Medical Evaluation
A medical examination not only determines whether a claimant is indeed injured but also provides insight surrounding the circumstances of the accident. No honest claimant would refuse a medical evaluation, especially when the claimant is made aware that the procedure is free.
The Claimant Waits Until the Next Monday Morning to File a Report
This is considered suspicious behavior because of the likelihood that the accident may have happened over the weekend and not during work hours. This means that the claimant may not have been at work, nor could the claimant have been injured while performing duties related to his or her job.
Moreover, most legitimate workers’ compensation claims are filed without delay. Some claimants even go as far as to submit fake medical examination results. It’s for this reason that employers also need to know what is a hospital canvass, how to perform it, and how to use this information in order to determine the truthfulness of medical reports that come from the claimant.
Vague Report Details
There may be times when the vagueness of a report may be due to a claimant’s lack of ability to express themselves accurately. However, it’s rare that a claimant gives self-contradicting details of the accident. While this is not a basis for fraud, it should serve as a cause of suspicion. This is especially true when the claimant claims that there were no witnesses to the accident.
This is because the burden of proof lies with the claimant to convince the court that an accident truly happened during the performance of duties related to the claimant’s job. It is not the employer’s legal burden to prove that there was no accident. If the claimant’s report is vague, and the claimant insists that there were no witnesses, the claimant is actually hurting the claim they filed.
A workers’ compensation claim is not a complaint against your business and it does not have an adverse effect on your legal standing as an employer, However, as mentioned earlier, businesses lose a significant amount of money on false workers’ compensation claims. Always give your employees the benefit of the doubt, but also be wary of the signs that could be indicative of workers compensation fraud. Most importantly, it’s best to ensure that your business premises are safe to prevent any potential claims in the future.
