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Worker’s Comp is Costing You Money
By Randy Wyles | August 13, 2010
Let’s be honest; employees who file fraudulent workers’ compensation claims are thieves – criminals – nothing more and nothing less. Some see it as “easy money” – a victimless crime. Others see it as a way of supplementing what their employer pays them or a chance to “make up” for that low salary or hourly wage.
No matter what the reason or justification, about 30-percent of all workers’ comp claims are fraudulent which costs the insurance companies more money and that, in turn, costs the employers – who must buy workers comp insurance – more money. Eventually, a company has less money to hire workers or to provide added benefits for the existing employees, which means the fraudulent claimant is costing jobs and benefits. It is NOT a victimless crime.
While an insurer will certainly pay a legitimate claim, insurance companies – and even the employers caught in the financial middle of it all – will usually hire private investigators to discover the truth about a claim that is “suspect.” What makes a claim “suspect” as far as insurance companies are concerned? It’s usually a number of factors that, if standing alone may not make a difference, but when combined with other elements form an environment of suspicion about the claim.
For example; there were no witnesses to the accident or injury – or only close friends or co-workers of the claimant saw the accident resulting in the injury. Perhaps the witnesses’ statements don’t match the account presented by the claimant or the claimant simply can’t recall specific details about the incident.
When investigating the case, the history of the claimant usually provides clues – such as the fact that the claimant frequently misses work or has had disciplinary problems at work. The claimant may also have a history of brief employment at numerous jobs in a relatively short period of time prior to his or her current employment. The claimant may have also filed numerous claims at the prior jobs. Perhaps the claimant is a new employee looking to start the claims “cycle” all over again with a new employer.
There may be obvious situations that would give the claimant motivation to file a false claim; the union he or she is a member of is about to go on strike – meaning no pay check for a while. He or she is about to go on vacation or has just returned and a little more paid time off seems like a good idea. Perhaps the claimant has just given noticed to leave the company or he or she is about to retire and would like a little extra cash to leave with.
A look at the claimant’s personal life away from work can also provide some evidence. If the claimant is having financial difficulties, a worker’s comp claim could be the answer they need – especially if the claimant has a sideline business doing home repairs, deck construction, carpentry, etc. It’s possible they would file a claim to have the time off to take more outside work – while still being paid by their primary employer.
There are many, many more clues and “tells” that a professional knows to look for – which is why private investigators have proven to be extremely valuable to workers’ comp insurers and their client companies.
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