Work comp claims are no walk in the park for the employers or employees.
Injured workers are stressed out about their health and livelihood. While bosses are concerned about the well-being of the worker and liability of the employer in regards to the incident.
A carried out luminous plan to handle work comp incidents after an injury can guide claims in the right direction for success.
The plan should include running through a list of red flags directed towards the employee work injury compensation fraud.
Identify the following red flags and reporting them to an adjuster right away, is key to compensability and can onset of a claim. Below are a few:
1.)Incident occurs on Monday or FridayAlleged injuries that occur on a Monday morning or a Friday afternoon that are not reported until the following Monday; the injury can be a result of some weekend mischief, or the employee may have plans for the weekend.
2.) BeefEmployee may have been rejected or looked over for a promotion, denied vacation, or laid off. Other influences may include a strike, end of project, or end of seasonal work.
3.) No WitnessesEmployee is the only witness to the incident. Also very suspect when the incident occurs in an area that is typically not occupied in the work environment or a location where there are no cameras.
4.) HistoryNot the employee's first incident. Be alert to a history of prior claims/incidents, although all records will not be accessible immediately you can verify if other incidents took place.
5.) DelaysEmployee stalled to report the incident. Or use the common, "I thought the pain would go away or get better."
6.) Story ChangesDetails of incident continuously change and eventually the story does not add up. Rumors of the incident arise with variations of the details. Employer informed a different story, doctor was advised another, etc.
7.) No Contact or Difficult Time ContactingUnable to make contact or having a hard time making contacting with the employee when they are allegedly disabled and at home.
8.) Lawyer or Doctor ReputationsReputation of lawyers and doctors with involvement in suspicious claims, that being a bad rep.
9.) Doctor SwitchEmployee changes doctors or medical providers upon receiving a release for work, or frequently changes doctors. This maybe a sign the employee conspiring different stories to the health care providers.
10.) Third PartiesThird parties involved in the incident maybe subrogation. Employers and insurance carriers have subrogation interest, or a right to recover the money spent due to the actions of a negligent third party. Employees stands to benefit by making a claim for pain and suffering.
A warning- Assuming the injured employee is not being truthful can deteriorate the relationship.
Facts should be transparent focus on how to handle and investigate claims prior to any injuries occurring. Both employers and employees should have the same outlook with that being the well-being of the injured employee.
If you have any doubts or questions contact the experts, National SIU for a consultation by phone (800)960-6748, email email@example.com or visit our site www.nsiu.com