Suspicious Behaviors

Suspicious Behaviors

There are a lot of bad ways for your company to get separated from its money, but arguably one of the worst would be false workers compensation claims made by unscrupulous employees. It’s theft. It’s gaming the system. It’s morally wrong and could cost your company a great deal.

Actually, if you think about it, workers comp fraud costs every company a great deal. Crimes that ultimately affect the cost of workers comp coverage go on to create premium increases for every company enrolled in the system, not to mention innocent workers too. As such, it’s essential employers understand what kinds of things can stand out as suspicious.

The following elements could be signs that something’s fishy. It’s not always a sure-thing, but their frequent association with false claims merits a closer look from employers at the very least.


Has there been drama? Any beefs goin’ on?

False claims have historically been a rather favored tactic among disgruntled employees who feel they have no other method of retaliating against employers with whom they’re having a disagreement. It’s a lowly tactic, sure, but one that could also come with a payoff if done right, making it attractive to angry workers. This has been found to be particularly the case among fraudsters who may have already been facing an impending disciplinary action or termination. If you’ve got an injured employee with a grudge, it might be worth investigating further. Consider their motive.


Can I get a witness?

If there wasn’t anyone around to witness the reported injury or any surveillance footage of the incident, you might have a case of fraud on your hands. It depends, though, because legitimate claims are not always observed by others. Witnesses are actually a good thing for honest employees that are injured in the course of their work duties, because they can help corroborate the injured party’s claim. Fraudsters would likely prefer their false claims to happen apart from anyone that could call them out on it. In any case, the absence of witnesses is problematic and could be a red flag.


Ever ski a black diamond hill, bruh?  

If you happen to know one of your employees has hobbies outside of work that could have contributed to or exacerbated the circumstances of an injury they’re reporting, it might be a good idea to examine the claim more closely. Our insurance sources frequently cite a Monday/Friday rule of thumb as a common warning sign among false claims. If the injury happened early on a Monday morning or late on a Friday when there’s a reduced chance of witnesses, it could be a sign the injury actually happened off duty. If that world-class skier among your employees suddenly twists his knee first thing on a Monday morning, it should alert your inner watchdog.


Haven’t I seen you in this lineup before?

According to the U.S. National Library of Medicine, 37 percent of people who file an initial workers comp claim go on to file a second claim, and nearly 80 percent of those people file a second claim for a second injury. The cases examined in that study were not examples of fraud, but they do reflect the notion that one claim frequently begets another, and business owners need to examine their operational procedures if multiple claims have been filed by the same employee. Could it be fraud? Sure, but if the working conditions haven’t changed, then a legit injury could absolutely happen a second time.


The facts, m’am. Just the facts.

Interestingly, the amount of detail provided in an accident report can be very telling. If a person’s lying about what happened, they usually do one of two things: they either provide only vague details or they go overboard and provide way too many details.

When reviewing the circumstances of an accident, an employer needs to read into it a bit like an investigator would. Did the claimant provide you with enough descriptive language to complete a full-length novel? They may be fabricating some of it. Alternatively, did they provide only the gist of what happened? Maybe they’re just not good storytellers. An honest injured employee should be able to provide the pertinent details in a way that wouldn’t raise your eyebrows.


That wasn’t there a minute ago…

Be sure the details of the injury remain consistent across re-tellings of the incident. If a person’s making it up, they’re likely to have some variations and changes in their story.

Also, on the subject of changes, if your injured employee has a history of major changes, you might have something suspicious taking place. Has their address changed? Have they switched jobs frequently? Have they recently changed their medical providers? Are they suddenly hard to get ahold of when you call? These can all be signs that something is amiss.


Not yet. I need more time.

Lastly, another behavior pattern you should keep an eye on is a person’s willingness or unwillingness to return to work. Most employers can make reasonable accommodations to get employees back to work at least in some capacity, which can help offset everyone’s losses due to an injury. Honest employees would likely want to get back to their normal lives and wages as soon as possible, but folks who are committing fraud are going to want to remain on their ill-gotten vacation for as long as possible.


Keep an eye out.

Knowing what to look out for is your best bet for protecting your company from workers compensation fraud. Don’t be afraid to make an inquiry if you’re concerned something’s going on. Not doing so could result in major losses for your company and the honest employees that workers comp is intended to protect. Stay safe.