Have you ever gotten the feeling that an employee claiming workers’ comp wasn’t really injured, or wasn’t really injured on the job? Here’s a list of “red flags” to watch out for, courtesy of Cathy Divodi of Artemis Claims Consulting in Santa Rosa. Divodi spoke at ERI’s recent 2008 California Employment Law Update conference in San Francisco.
Please note that these red flags serve only as an alert to the possibility of fraud or abuse:
- The alleged injury occurs prior to or just after a strike, layoff, plant closure, job termination, completion of seasonal or temporary work, or notice of employer relocation.
- Employee reports an alleged injury immediately following disciplinary action, notice of probation or demotion, or being passed over for a promotion.
- Employee has a history of personal injury, workers’ comp claims, and/or reporting “subjective” injuries.
- The alleged injury relates to a pre-existing medical condition or health problem.
- The employee uses addresses of friends, family, or post office boxes; has no known permanent address; or moves frequently.
- The employee’s family members know nothing about the claim.
- The employee has high-risk hobbies (e.g., skydiving).
- The employee’s version of the accident has inconsistencies.
- There are no witnesses to the accident/injury, or the witness version conflicts with the employee’s version
- The employee fails to report the injury in a timely manner.
- Type of injury or accident is unusual for the employee’s line of work.
- Facts regarding the accident are related differently in various medical reports, statements, and employer’s first report of injury.
- The employee refuses to produce, or cannot produce, solid or correct identification.
Don’t let unfamiliarity with the workers’ comp rules come back to bite you. Check out our exclusive Special Report, Understanding Workers’ Compensation: A Guide for California Employers.
Next week we’ll have 14 additional important red flags to watch out for, so stay tuned.
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