First Choice Insurance Consulting FCIC

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Believe it or not, there are people out there that will take advantage of the system.

Here Are 15 Warning Signs of Workers Comp Fraud

1. Monday Morning:
The alleged injury occurs either “first thing Monday morning,” or late on a Friday afternoon but
not reported until Monday.

2. Employment Change:
The reported accident occurs immediately before or after a strike, a layoff, the end of a
big project or at the conclusion of seasonal work.

3. Job Termination:
If an employee files a post-termination claim:
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Was the alleged injury reported by the employee prior to termination?
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Did the employee exhaust his/her unemployment benefits prior to claiming workers’ compensation benefits?

4. History of Changes:
The claimant has a history of frequently changing physicians, addresses and places of
employment.

5.Medical History:
The employee has a pre-existing medical condition that is similar to the alleged work injury.

6. No Witnesses:
The accident has no witnesses, and the employee's own description does not logically support
the cause of injury.

7. Conflicting Descriptions:
The employee's description of the accident conflicts with the medical history or First
Report of Injury.

8. History of Claims:
The claimant has a history of numerous suspicious or litigated claims.

9. Treatment is Refused:
The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.

10. Late Reporting:
The employee delays reporting the claim without a reasonable explanation.

11. Hard to Reach:
You have difficulty contacting a claimant at home, when he/she is allegedly disabled.

12. Moonlighting:
Does the employee have another paying job or do volunteer work?

13. Unusual Coincidence:
There is an unusual coincidence between the employee’s alleged date of injury and
his/her need for personal time off.

14. Financial Problems:
The employee has tried to borrow money from co-workers or the company, or requested
pay advances.

15. Hobbies:
The employee has a hobby that could cause an injury similar to the alleged work injury.

Do you think Phil will see his shadow? We will have to wait and see!