Are you a California employer who has received a workers’ compensation claim that seems suspicious? If so, strongly consider reviewing the case with a California workers’ compensation defense attorney.
It’s not always easy to determine whether an employee appears to be engaging in workers’ compensation fraud when filing a claim. However, there are certain warning signs you can look out for that might indicate a claim is fraudulent. They include (but are not necessarily limited to) the following.
Lack of Witnesses
Of course, there are times when workers are injured on the job and no witnesses are around to see the accident happen. That said, if an employee is unable to name any witnesses to their accident, while this fact alone does not guarantee they are committing fraud, it could be a warning sign to take note of if you already have additional reasons to suspect they are inaccurately describing the circumstances.
Refusing Treatment
A claimant might state they have sustained an injury or developed a medical condition as a result of their employment, but they may nevertheless be unwilling to receive treatment or undergo any tests that would be necessary to officially diagnose their condition. Perhaps they know that undergoing such treatment or tests would confirm they are exaggerating the severity of their injuries or illness.
Past Claims
It’s important to remember that none of these warning signs indicate beyond a shadow of a doubt that an employee is engaging in fraud when filing a workers’ compensation claim. It’s entirely possible an employee has a history of filing claims (whether within your company or another) because they have been genuinely injured at work multiple times. Still, you may have good reason to be suspicious if an employee does seem to file claims significantly more often than others who perform the same type of work in the same environment.
Social Media Posts
Social media has been very useful for insurance companies and workers’ compensation defense attorneys as a means of investigating whether claimants are engaging in fraud. For example, perhaps an employee claims to have sustained major injuries that significantly impact their mobility, but they post pictures of themselves on social media participating in activities that their alleged injuries should stop them from participating in.
When investigating suspicious workers’ compensation claims, pay close attention to any social media accounts and other digital sources of information about a claimant. Many who engage in fraud don’t consider how what they post online can provide evidence that they do not deserve to recover the workers’ compensation benefits they may be seeking.
Inconsistent Descriptions
If an employee can’t seem to keep their story straight regarding an accident, or if it conflicts with the statements of witnesses, there is a relatively good chance fraud is being committed.
Don’t wait to contact a California workers’ compensation defense law firm if any of these warning signs give you a reason to suspect an employee is committing workers’ compensation fraud. Our team at Sacks Law Group, APC will review your case and determine if you may be justified in denying a workers’ compensation claim. Call us at 310-216-7778 or contact us online for more information.
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