In a sampling of your restaurant Worker Compensation Claims last year, approximately 20% of the claims had the potential of being denied for various reasons. Obviously, everyone wants to pay legitimate claims, but paying fraudulent claims really hurts your long-term insurance costs. Know the possible fraudulent signs and document the details during your accident investigation. With the right insurance company partner, this information could result in the claim being denied. Preventing illegal activity is every ones responsibility.
Know the Warning Signs:
1. Monday Morning Reports:
The alleged injury occurs first thing on Monday morning, or the injury occurs late on Friday afternoon but is not reported until Monday.
2. Suspicious Providers:
An employee’s medical providers or legal consultants have a history of handling suspicious claims, or the same doctors and lawyers are used by groups of claimants.
3. Conflicting Descriptions:
The employee’s description of the accident conflicts with the medical history or first report of injury.
4. Treatment is Refused:
The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
5. Claimant is Hard to Reach:
The allegedly disabled claimant is hard to reach at home.
6. Employment Change:
The reported accident occurred immediately before or after a strike, job termination, layoff, end of a big project or at the conclusion of seasonal work.
7. No Witnesses:
There are no witnesses to the accident and the employee’s own description does not logically support the cause of injury.
8. History of Claims:
The claimant has a history of a number of suspicious or litigated claims.
9. Late Reporting:
The employee delays reporting the claim without a reasonable explanation.
The claimant has a history of frequently changing physicians, changing addresses and numerous past employment changes.