10 ways for employers to combat workers' compensation fraud

1. Promote a fraud-free workplace

Talk to your employees about workers’ compensation. Eliminate misconceptions by explaining what it is, how it works and your zero tolerance stance on fraud. Use posters and employee newsletters to spotlight workers’ comp fraud as a serious crime. Also, let employees know how they can report fraud anonymously.

2. Use sound hiring practices

Stop workers’ comp fraud from the start. Run thorough background checks on would-be employees before hiring. You might be surprised to find past phony workers’ comp claims or other types of fraud convictions. If you have questions about anything you find, ask them to explain.

3. Install video equipment

Monitoring is a proven spoiler of fraud and other workplace crimes.

4. Institute a drug testing policy

Drug users do not make the best employees. They’re unsafe workers and are more likely to file false claims. Spot potential cheats and keep safety a priority by conducting pre-employment background screening and testing for alcohol and drug use.

5. Have a plan if someone is injured

Designate someone to be in charge when an injury happens

• Promptly recommend your predetermined medical provider

• Get a description of the accident and injury. It is always best to have the injured worker write out this statement. If he / she is unable to write, record the person’s statement then have [it] transcribed. Present the completed statement to the claimant for his /her signature

• Report the injury right away to your administrator

• Preserve workplace evidence

• Get names of witnesses

6. Start a safety program

Make workplace safety a priority.

· Hold regular safety meetings;

· Use posters, flyers and newsletters to stress safety procedures; and

· Reward workers for meeting safety milestones.

A safe workplace makes fake injuries harder to pass off as legitimate.

7. Know the red flags of fraud

· The injury occurs first thing Monday morning or it happens late Friday afternoon but isn’t reported until the following Monday morning

· The employee’s description of the accident conflicts with the medical history or first report of injury.

· The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.

· The allegedly disabled claimant is hard to reach at home.

· 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.

· There are no witnesses to the accident and the employee’s own description does not logically support the cause of injury.

· Exaggerated details about incident or symptoms

· The claimant has a history of a number of suspicious or litigated claims.

· Co-worker skepticism

· The claimant has a history of frequently changing physicians, changing addresses and numerous past employment changes.

8. Pay attention to worker scuttlebutt

After a workplace injury, and throughout the claims process, rumors of foul play may filter through the workplace. Keeping an ear to the grapevine may help in weighing a claim’s validity.

9. Establish and implement an post-injury investigation policy

Inform employees that all work related injuries will be formally and promptly investigated. Institute a written policy that all injuries resulting in a workers’ compensation claim may be subject to covert surveillance to ensure integrity throughout the recovery process.

10. Pave the way for a return to work

Let employees know every attempt will be made to get injured employees well again and back to work. Prepare a written return-to-work plan that includes temporary or alternative duties.

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