The biggest incidents of workers’ compensation fraud come from employers who misclassify their employees and aim to unfairly deny their workplace injury claims. However, insurers are always on the lookout for individual incidents of fraud among workers.
Because of the scrutiny on “fraudulent claims,” your workers’ compensation claim can be delayed or denied unfairly — through no fault of your own. Your case can be “red-flagged” just because of when or how it occurs.
What makes a workers’ comp claim look suspicious to an insurer?
Insurance companies periodically offer lists of warning signs that are designed to make employers and case managers suspect that a worker is lying about their illness or injury. That can put perfectly valid claims under a microscope.
Your claim can be red-flagged because:
- You can’t remember exactly how an accident happened.
- You protest being returned to work activity before you’re ready.
- Your injuries are considered “subjective” (like back pain or pulled muscles).
- You don’t answer your phone or the door when you’re expected to be home sick.
- You’re too close to retirement or are a new hire.
- You were injured on a Friday afternoon or a Monday morning.
- Some of your co-workers spread the rumor that you’re faking.
- You happened to be alone when you were injured.
- You were in an area that’s not usual for your job when you were hurt.
- You’ve ever had a prior workers’ comp claim with another employer.
- You seem “too familiar” with the workers’ comp system.
In other words, almost anything can be used to justify the idea that you might be faking your illness or injury.
What can you do if your workers’ comp claim is being denied or delayed?
A workplace injury or illness has the potential to devastate your financial security and hurt your family. Your health is also at risk, the longer your claim is delayed. Talk to an experienced attorney about your claim right away.