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Tips for Evaluating Workers Comp Claims

Fraud is a worsening problem in the workers compensation system. While regulators and law enforcement personnel certainly do what they can to root out fraud and bring perpetrators to justice, the first line of defense — not just against fraud, but also against abuse and overreaching in general — must be the employers and their insurance carriers.

Regulators may pursue legal action against the most egregious fraudsters. However, most abuse is more subtle. There are several red flags employers and insurers should look for when examining a workers’ compensation claim:

  • Long delays before filing — Sometimes, injuries do not become apparent right away. Other employees may try to “tough it out” before finally filing a claim. While there are legitimate reasons an employee may not file a claim promptly, it can also be a sign of fabrication and opportunism. It is important to consider the type of injury and determine if the delay makes sense under the circumstances.
  • Injuries that do not fit the employee’s job description — There are many ways for an employee to get hurt on the job. However, sometimes the alleged injury simply does not make sense given the employee’s duties. An example would be an employee who does not do any significant lifting on the job complaining of a back injury.
  • A history of repeated claims — Some people are clumsy. Others are just unlucky. In either case, a history of repeated workers compensation claims does not necessarily mean an employee is abusing the system. Nevertheless, a claim from an employee with a history of regular and repeated on-the-job injuries may deserve a heightened degree of scrutiny.

Employers and insurers should not make it their policy to resist every workers compensation claim they receive. However, when a claim does appear to be suspect, your business should not be afraid to take a stand with the help of an experienced California workers compensation defense firm.

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