Protecting the Best Companies from Fraudulent Claims

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fraud indicators

The lists below will help employers know what to look for when identifying possible fraudulent behaviors. Identification of any one of the following indicators does not mean that fraud exists, but may indicate further investigation is warranted.

Early Attorney involvement – notorious claimant attorney
Repetitive Medical
Physician Change – notorious claimant physician
Conflicting Medical
Rumors & Tips
Soft Tissue Injuries
Disability Beyond normal AMA Guidelines
Claimant never home or able to come to phone
Missed therapy and medical appointments
Refusal to cooperate with case managers
Claimant’s that “live” claim on a daily basis
No witness accidents
Monday morning accidents
PO Boxes
Change of address
Unreasonable demands
History of malingering/exaggerating or taking time off work
Injury prior to termination, lay-off, shift change or disciplinary action
Disgruntled employee
History of self-employment
New employee
Appearance – calluses, grease on hands and nails, muscular, tan
Threatens/complains to upper management
History of recreational or sporting activities
Exaggerates pain and symptoms
Family issues
Examiner intuition