INDICATORS OF WORKERS COMPENSATION FRAUD
Monday morning injury report for an incident that occurred the week prior
Injury report for an incident occurring PRIOR to anyone else arriving for work
No eyewitnesses to the incident in areas where witnesses would be expected
Injury reported following notice of termination of employment
Injury reported following notice of pending layoffs
Incident occurs prior to scheduled layoff, job termination or job completion
Serious injury reported any time other than immediately after the incident
Injured worker cannot be reached by phone because he or she is never home
Injured worker moves out of state or country shortly after filing claim
Injured worker refuses (or delays) diagnostic procedures to confirm injury
Employer's loss description conflicts with description give to medical provider
Injury is not consistent with nature of business
Injured worker cannot recall the date, time and place of the incident
Injured worker cannot recall the specific facts of the incident
The injury continues to expand to other areas of the body as time progresses
The injured worker has other employment
Tips from coworkers
Monday morning injury report for an incident that occurred the week prior
Injury report for an incident occurring PRIOR to anyone else arriving for work
No eyewitnesses to the incident in areas where witnesses would be expected
Injury reported following notice of termination of employment
Injury reported following notice of pending layoffs
Incident occurs prior to scheduled layoff, job termination or job completion
Serious injury reported any time other than immediately after the incident
Injured worker cannot be reached by phone because he or she is never home
Injured worker moves out of state or country shortly after filing claim
Injured worker refuses (or delays) diagnostic procedures to confirm injury
Employer's loss description conflicts with description give to medical provider
Injury is not consistent with nature of business
Injured worker cannot recall the date, time and place of the incident
Injured worker cannot recall the specific facts of the incident
The injury continues to expand to other areas of the body as time progresses
The injured worker has other employment
Tips from coworkers
| According to the National Insurance Crime Bureau, Workers Compensation fraud costs the Insurance Industry BILLIONS of dollars each year. Some of these costs are related to exaggerated injuries, inflated medical costs, and even outright fabrication of injury claims. While most of the claims you see are legitimate, those that are not need to be identified and exposed. |
| Sullivan Investigation Service, Inc. |
| Since 2004 |
Workers Compensation
| Thorough investigations protect both your workers and your company's assets |
NOTE: The fraud indicators identified on this website are examples of issues that may exist in a
claim file. The lists provided are not exhaustive. The existence of any one or any combination of
indicators is not necessarily evidence of fraud. A complete and thorough investigation is needed to
review all the information presented by the parties involved to ensure that it is factual and accurate.
claim file. The lists provided are not exhaustive. The existence of any one or any combination of
indicators is not necessarily evidence of fraud. A complete and thorough investigation is needed to
review all the information presented by the parties involved to ensure that it is factual and accurate.
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